The AmeriHealth Dosage and Frequency Program will be expanded to include
three additional drugs, on the effective dates listed below.
The following is the comprehensive list of drugs that will be reviewed for
dosage and frequency:
- Avastin® (bevacizumab)*†
- Bivigam® (immune globulin intravenous [human])
- Blincyto® (blinatumomab)
- Carimune® NF (immune globulin intravenous [human])
- Cuvitru™ (immune globulin subcutaneous [human])
- Entyvio® (vedolizumab)
- Erbitux® (cetuximab)
- Flebogamma® (immune globulin intravenous [human])
- Flebogamma® DIF (immune globulin intravenous [human])
- Gamastan® S/D (immune globulin [human])
- Gammagard® Liquid (immune globulin infusion [human])
- Gammagard® S/D (immune globulin intravenous [human])
- Gammaked™ (immune globulin [human])
- Gammaplex® (immune globulin intravenous [human])
- Gamunex®-C (immune globulin injection [human])
- Herceptin® (trastuzumab)†
- Hizentra® (immune globulin subcutaneous [human])
- HyQvia® (immune globulin infusion [human])
- Inflectra® (infliximab-dyyb)
- Ixifi™ (infliximab-qbtx)
- Kanuma® (sebelipase alfa) – NEW FOR DECEMBER 3, 2018
- Mvasi™ (bevacizumab-awwb)*
- Octagam® (immune globulin intravenous [human])
- Ogivri™(trastuzumab-dkst)
- Onpattro™ (patisiran) – NEW FOR DECEMBER 3, 2018
- Panzyga® (immunoglobulin intravenous)
- Privigen® (immune globulin intravenous)
- Remicade® (infliximab)†
- Renflexis® (infliximab-abda)
- Rituxan® (rituximab)†
- Rituxan Hycela™ (rituximab/hyaluronidase human for
subcutaneous injection)
- Sandostatin® LAR Depot (octreotide acetate)
- Spinraza® (nusinersen) – NEW FOR DECEMBER 3, 2018
- Stelara® (ustekinumab)
- Xolair® (omalizumab)
- Yervoy® (ipilimumab)
About the Dosage and Frequency Program
Since January 1, 2011, AmeriHealth has reviewed the requested dosage and
frequency of administration for select drugs as part of the precertification
process. Coverage of the drugs included in this program is contingent upon
review by AmeriHealth for appropriate dosage and frequency. Providers who
request coverage above the dosage and frequency requirements listed in the
medical policies for each drug will be required to submit documentation (i.e.,
published peer-reviewed literature) to AmeriHealth to support the request.
Members who are currently receiving any drug on this program, are subject to
Dosage and Frequency review at every renewal of precertification.
AmeriHealth reserves the right to conduct a post-payment review and audit of
claims submitted for any drug that is part of the Dosage and Frequency Program
and may recover payments that exceed the amount approved through the
precertification process. For more information on the dosage and frequency
guidelines, please refer to the specific policies for each drug included in the
program.
If you have any questions about the precertification process for drugs
included in the Dosage and Frequency Program, please call the AmeriHealth
Clinical Services department at 1-888-YOUR-AH1 for
AmeriHealth New Jersey and 1-800-275-2583 for
AmeriHealth Pennsylvania.
Updated policies
Medical policies for the following three drugs are currently in development
or have been posted as a Notification of a future policy version. In lieu of
updated policies, AmeriHealth will follow the dosage and frequency guidelines
listed in the prescribing information for each drug.
- #08.01.28: Sebelipase alfa (Kanuma®)
– Notification
- #08.01.36: Nusinersen (Spinraza™)
- #08.01.50: Patisiran (Onpattro™)
To access these policies, visit our Medical Policy
Portal. Select Accept and Go to Medical Policy
Online and then type the policy name or number in the Search
field.
*Bevacizumab (Avastin®,
Mvasi™) only requires precertification approval for dosage and
frequency for oncologic indications. Coverage requests for intravitreal
injection of bevacizumab (Avastin®, Mvasi™) to
treat the ophthalmologic conditions listed in this drug’s policies do not
require precertification.
†Dosage and frequency
requirements apply to all U.S. Food and Drug Administration-approved
biosimilars to this originator product.