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Reminder: Updates to the list of specialty drugs that require precertification

June 15, 2018

As of June 15, 2018, the following specialty drugs, which are eligible for coverage under the medical benefit, now require precertification for Independence commercial and Medicare Advantage HMO and PPO members:

  • Crysvita? (burosumab-twza)
  • IlumyaTM (tildrakizumab-asmn)
  • TrogarzoTM (ibalizumab-uiyk)

Note: Independence's medical policies for these drugs are currently in development. Until these policies are published, precertification review for these drugs will be based on the U.S. Food and Drug Administration (FDA)-approved indication.

In addition, the following drugs are currently pending approval from the FDA. These drugs will require precertification from Independence once they receive FDA approval:

  • a biosimilar for the drug Soliris? (eculizumab)
  • the anti-PD-1 monoclonal antibody cemiplimab

These changes are reflected in an updated precertification requirement list, which has been posted to our website.


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