As a reminder, effective January 1, 2019, the following specialty drugs, which are eligible for coverage under the medical benefit for AmeriHealth New Jersey members, will require precertification:

• Azedra^? (ultratrace iobenguane I-131)* – Antineoplastic Agents
• Crysvita^? (burosumab-twza) – Miscellaneous Therapeutic Agents
• Fulphila^TM (pegfilgrastim-jmdb) – Colony-Stimulating Factors
• Gamifant^? (emapalumab-lzsg) – Miscellaneous Therapeutic Agents
• Ilaris^? (canakinumab) – Miscellaneous Therapeutic Agents
• Ilumya^TM (tildrakizumab-asmn) – Immunological Agents
• Jivi^? (recombinant PEGylated-aucl) – Hemophilia/Coagulation Factors
• Krystexxa^? (pegloticase) – Miscellaneous Therapeutic Agents
• Libtayo^? (cemiplimab-rwlc) – Anti-PD-1/PD-L1 Human Monoclonal Antibodies
• Lumoxiti^TM (moxetumomab pasudotox-tdfk) – Antineoplastic Agents
• Onpattro^TM (patisiran) – Miscellaneous Therapeutic Agents
• Panzyga^? (immunoglobulin intravenous [human]) – IVIG/SCIG
• Poteligeo^? (mogamulizumab-kpkc) – Antineoplastic Agents
• Revcovi^TM (elapegademase-lvlr) – Enzyme Replacement Agents
• TriVisc^TM (sodium hyaluronate) – Hyaluronate Acid Products
• Trogarzo^TM (ibalizumab-uiyk) – Miscellaneous Therapeutic Agents

In addition, the following drugs are currently pending approval from the U.S. Food and Drug Administration (FDA) and will require precertification for AmeriHealth New Jersey members once they receive FDA approval in 2019, or as of January 1, 2019, for any drug approved in 2018:

• eculizumab biosimilar – Miscellaneous Therapeutic Agents
• Elzonris^TM (tagraxofusp) – Antineoplastic Agents
• ravulizumab – Miscellaneous Therapeutic Agents
• sacituzumab govitecan – Antineoplastic Agents

Lastly, all drugs that are classified by AmeriHealth New Jersey as Gene Therapy (e.g., Luxturna^TM [voretigene neparvovec-rzyl]) will require precertification as of January 1, 2019.

These changes are reflected in an updated precertification requirement list, which has been posted to our website.

*Precertification review is provided by CareCore National, LLC d/b/a eviCore healthcare (eviCore). Precertification review benefit varies based on decision by member’s employer group.