Attention! An update has been made to this article.

Effective January 1, 2018, AmeriHealth will make the changes detailed below to specialty drugs requiring precertification under the medical benefit.

Additions

New precertification requirements will apply to AmeriHealth members for the following specialty drugs as of January 1, 2018, unless noted otherwise:

• Fasenra^? (benralizumab)*
• Luxturna^? (voretigene neparvovec)
• Mvasi^? (bevacizumab-awwb)
• Radicava^? (edaravone)
• Somatuline^? Depot (lanreotide)
• Sustol^? (granisetron extended release)

In addition, the following drugs are currently pending approval from the U.S. Food and Drug Administration (FDA). These drugs will require precertification from AmeriHealth once they receive FDA approval in 2018, or on January 1, 2018, for any drug approved in 2017:

• Exenatide sustained-release ITCA 650
• Herceptin^? (trastuzumab) biosimilar
• Neulasta^? (pegfilgrastim) biosimilar
• Rituxan^? (rituximab) biosimilar

Deletions

The following drugs will no longer require precertification from AmeriHealth as of January 1, 2018, unless noted otherwise:

• Berinert^? (C1 esterase inhibitor [human])^?
• Cinryze^? (C1 esterase inhibitor [human])^?
• Cubicin^? (daptomycin)
• Faslodex^? (fulvestrant)^?
• Kalbitor^? (ecallantide)
• Myozyme^? (alglucosidase alfa)
• Ruconest^? (C1 esterase inhibitor recombinant)^?
• Synribo^? (omacetaxine mepesuccinate)

These changes are reflected in an updated precertification requirement list, which has been posted to the AmeriHealth New Jersey and AmeriHealth Pennsylvania websites.

Please note: In a previously published version of this article, AmeriHealth stated that the drugs Emend^? for injection (fosaprepitant), Cinvanti^? (aprepitant), and Varubi^? (rolapitant) would require precertification approval effective January 1, 2018. Based on provider feedback, AmeriHealth has reconsidered this position. Therefore, these three drugs will not require precertification approval.

*This drug will require precertification as of March 1, 2018, for AmeriHealth New Jersey members.

^?Effective January 1, 2018, these drugs will no longer be eligible for coverage under the medical benefit. As self-administered drugs, they will now be eligible for coverage under the pharmacy benefit for members with AmeriHealth prescription drug coverage. Members who do not have prescription drug coverage through AmeriHealth should contact their pharmacy benefits manager to determine if coverage for these self-administered drugs is available.

^?This drug will no longer require precertification as of March 1, 2018, for AmeriHealth New Jersey members.