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Effective January 1, 2014, AmeriHealth uses a single
precertification requirement list across all managed care
products. This change was made as we continue to look
for ways to improve and simplify the precertification
process.
For the most up-to-date list of services and specialty
drugs that require precertification, download the
latest version of the precertification requirement list
from our website.
As a reminder, significant changes went into effect
January 1, 2014, for the following three categories:
- Outpatient surgical procedures. For standard HMO
products, only select outpatient surgical procedures
require precertification.
- Durable medical equipment (DME) and prosthetic items. The
precertification requirement list has been
updated to specify only certain DME and prosthetic
items that require precertification, regardless of the cost
of these items.
- Injectable and infusion therapy drugs. Precertification
approval has been added for Acthar H.P.?, Adcetris?,
Kyprolis?, Naglazyme?, Perjeta?,
Simponi? Aria, Veletri?,
and Xofigo?. Precertification is no longer required for
Lucentis?, Macugen?, Mozobil?, and
Temodar?. In
addition, precertification requirements for 23 drugs have
been removed for members who have Flex products.
These drugs include Aranesp?, Neulasta?, and
Eligard?.
If you have any questions, please contact Cheryl McGurk,
Manager of Precertification, at 215-241-4542.
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