Since January 1, 2011, AmeriHealth has reviewed the dose and frequency of
administration for eight drugs as part of the precertification process. By
reviewing this information, AmeriHealth can confirm that requested coverage is
being authorized for the dose and at a frequency generally accepted by the
medical community as appropriate for the condition being treated. These eight
drugs are:
bevacizumab (Avastin
®)*
cetuximab (Erbitux
®)
immune globulin, intravenous (IVIG)
infliximab (Remicade
®)
onabotulinumtoxinA (Botox
®)
oxaliplatin (Eloxatin
®)
rituximab (Rituxan
®)
trastuzumab (Herceptin
®)
As a reminder, if, during the course of therapy for which precertification is
issued, the member?s dose, frequency, or regimen changes (based on factors such
as changes in member weight or incomplete therapeutic response), an amended
coverage request must be submitted to AmeriHealth for a new approval as part of
the precertification process.
AmeriHealth reserves the right to conduct post-payment review and audit of
claims submitted for these eight drugs and may recover payments made in excess
of the amount approved through the precertification process. Please refer to
the medical policies for each of these eight drugs for more information on the
Dosing and Frequency Guidelines associated with each one. To do so, visit our
Medical Policy
website, select Accept and Go to Medical Policy Online, and type the name of
the drug into the Search box. You can also access medical policies through the
NaviNet
® web portal by selecting Reference Tools from the Plan
Transactions menu and then Medical Policy.
Please call
1-800-275-2583 if you have any questions
about the precertification process for these drugs.
NaviNet® is a registered trademark of
NaviNet, Inc.