AmeriHealth and its affiliates (collectively, AmeriHealth) has made changes to the specialty medical benefit drugs in the Most Cost-Effective Setting Program.
As of July 1, 2022, the following drugs will be reviewed for setting, as well as medical necessity, as part of the precertification process:
- Amvuttra™ (vutrisiran)
- Enjaymo™ (sutimlimab-jome)
- Fylnetra™ (pegfilgrastim-pbbk)
- Releuko™ (filgrastim-ayow)
Members who have a current precertification approval to receive these drugs in a hospital outpatient facility may continue treatment in this setting until their precertification approval expires. At the next precertification review, AmeriHealth will evaluate the requested setting and make a coverage determination.
With our Most Cost-Effective Setting Program, AmeriHealth seeks to ensure that members receive treatment with specialty medical benefit drugs in settings that are safe and cost-effective.
Resources
For more information, including a list of all 84 drugs in the program, visit our Most Cost-Effective Setting Program webpages: