AmeriHealth seeks to ensure that our members receive injectable/infusion therapy drugs in a setting that is both safe and cost-effective. Since 2012, AmeriHealth has been reviewing the most appropriate setting for members to receive certain injectable and infusion therapy drugs eligible for coverage under the medical benefit. AmeriHealth has recently added the following new-to-market drugs to our Most Cost-Effective Setting Program, on the effective dates listed below:
- Cutaquig® (immune globulin subcutaneous [human]) –
AS OF DECEMBER 12, 2018
- Gamifant® (emapalumab-lzsg) –
AS OF NOVEMBER 20, 2018
- Udenyca™ (pegfilgrastim-cbqv) –
AS OF NOVEMBER 2, 2018
- Ultomiris™ (ravulizumab-cwvz) –
AS OF DECEMBER 21, 2018
New requests for these drugs will require review for setting, as well as medical necessity, during the precertification process. Members who have precertification approval to receive these drugs in a hospital outpatient facility may continue treatment in this setting until their current precertification approval expires. At the next precertification review, AmeriHealth will evaluate the requested setting and make a coverage determination.
Resources
Visit our Most Cost-Effective Setting Program webpage for more information, including a downloadable list of all 60 drugs on the program.