As a reminder, as of January 1, 2019, AmeriHealth Pennsylvania has updated its list of specialty drugs that require member cost-sharing (e.g., copayment, deductible, and coinsurance). Cost-sharing applies to select medical benefit specialty drugs for members who are enrolled in Commercial FLEX products and other select plans. The member’s cost-sharing amount is based on the terms of the member’s benefit contract. In accordance with your Provider Agreement, it is the provider’s responsibility to verify a member’s individual benefits and cost-share requirements.
The list has been expanded to include 161 drugs, including additions of the following:
- brexanolone*
- FulphilaTM (pegfilgrastim-jmdb)†
- Ilaris® (canakinumab)
- Jivi® (recombinant PEGylated-aucl)
- OnpattroTM (patisiran)
- Triptodur® (triptorelin)
- UltomirisTM (ravulizumab-cwvz)
In addition, all specialty drugs that are classified by AmeriHealth as Gene Therapy (e.g., LuxturnaTM [voretigene neparvovec-rzyl]) now require member cost-sharing.
The comprehensive list of specialty drugs with cost-sharing is now available on our website.
*Pending approval from the U.S. Food and Drug Administration (FDA).
†
Cost-sharing applies to all FDA-approved biosimilars to pegfilgrastim.