Effective January 1, 2020, the following specialty
drugs, which are eligible for coverage under the medical benefit for
AmeriHealth Pennsylvania members, will require precertification:
- Eylea® (aflibercept) – Ophthalmic agents
- KanjintiTM (trastuzumab-anns) – Cancer
- Lucentis® (ranibizumab) – Ophthalmic agents
- Macugen (pegaptanib) – Ophthalmic agents
- PolivyTM (polatuzumab vedotin-piiq) – Cancer
- Revatio® (sildenafil) – Pulmonary arterial
hypertension
- RuxienceTM (rituximab-pvvr) – Cancer
- SynojoyntTM (sodium hyaluronate) – Hyaluronate acid
products
- TriluronTM (sodium hyaluronate) – Hyaluronate acid
products
- Tyvaso® (treprostinil) – Pulmonary arterial
hypertension
- Ventavis® (iloprost) – Pulmonary arterial
hypertension
- Zirabev (bevacizumab-bvzr) – Cancer
In addition, the following drugs are currently pending approval from the
U.S. Food and Drug Administration (FDA) and will require precertification for
AmeriHealth Pennsylvania members once they receive FDA approval in 2020, or as
of January 1, 2020, for any drug approved in 2019:
- abicipar – Ophthalmic agents
- brolucizumab – Ophthalmic agents
- casimersen – Duchenne muscular dystrophy
- cosyntropin depot – Endocrine/metabolic agents
- crizanlizumab – Miscellaneous therapeutic agents
- eptinezumab – Miscellaneous therapeutic agents
- givosiran – Miscellaneous therapeutic agents
- golodirsen – Duchenne muscular dystrophy
- isatuximab – Cancer
- Lapelga (pegfilgrastim) – Colony-stimulating factor
- lisocabtagene maraleucel – Chimeric antigen receptor therapy
- margetuximab – Cancer
- Reblozyl (luspatercept-ammt) – Miscellaneous therapeutic agents
- RVT-802 – Miscellaneous therapeutic agents
- viltolarsen – Duchenne muscular dystrophy
- Zynteglo (betibeglogene darolentivec) – Gene Therapy
Lastly, the following drugs will no longer require precertification approval
from AmeriHealth as of January 1, 2020:
- Beleodaq® (belinostat) – Cancer
- FolotynTM (pralatrexate) – Cancer
- Imlygic® (talimogene laherparepvec) – Cancer
- Istodax® (romidepsin) – Cancer
- Monovisc® (high molecular weight hyaluronan) –
Hyaluronate acid products
Learn more
In the absence of a published medical policy on any of these newly approved
drugs, all requests will be subject to review in accordance with the
FDA-approved indications and AmeriHealth-recognized compendia.
These changes are reflected in an updated precertification requirement list,
which has been posted to our website.