As a reminder, as of July 1, 2019, the following specialty drugs, which are eligible for coverage under the medical benefit for AmeriHealth Pennsylvania members, require precertification:
- Asceniv™ (immune globulin intravenous, human-slra, 10% liquid) – Intravenous/Subcutaneous Immune Globulin (IVIG/SCIG)
- Evenity™ (romosozumab-aqqg) – Bone-Modifying Agents
- Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk) – Antineoplastic Agents
- Trazimera™ (trastuzumab-qyyp) – Antineoplastic Agents
In addition, the gene therapy drug Zolgensma® (onasemnogene abeparvovec-xioi) was updated to reflect its approval by the U.S. Food and Drug Administration (FDA) on May 24, 2019.
Updated policy
AmeriHealth Medical Policy 08.00.13u: Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG) was updated to include Asceniv.
Medical policies for all other drugs are currently in development. In lieu of published policies, requests for these drugs will be subject to FDA-approved indications and guidelines. To access medical policies, visit our Medical Policy Portal.
These changes are reflected in an updated precertification requirement list, posted on our website.