As of April 1, 2021, the following drugs were added to our Most Cost-Effective Setting Program:

• Evkeeza^® (evinacumab-dgnb)
• Tepezza^® (teprotumumab-trbw)  

Requests for these drugs 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.

To learn more about the new drugs added to the program, please read our announcement article.