As a reminder, effective January 1, 2019, the following
specialty drugs, which are eligible for coverage under the medical benefit for
Independence commercial and Medicare Advantage HMO and PPO members, will
require precertification:
- Azedra? (ultratrace iobenguane I-131)* – Antineoplastic
Agents
- Gamifant? (emapalumab-lzsg) – Miscellaneous Therapeutic
Agents
- Ilaris? (canakinumab) – Miscellaneous Therapeutic
Agents
- Jivi? (recombinant PEGylated-aucl) –
Hemophilia/Coagulation Factors
- Krystexxa? (pegloticase) – Miscellaneous Therapeutic
Agents
- LumoxitiTM (moxetumomab pasudotox-tdfk) – Antineoplastic
Agents
- Panzyga? (immunoglobulin intravenous [human]) –
IVIG/SCIG
- Poteligeo? (mogamulizumab-kpkc) – Antineoplastic
Agents
- RevcoviTM (elapegademase-lvlr) – Enzyme Replacement
Agents
- TruximaTM (rituximab-abbs) – Antineoplastic Agents
In addition, the following drugs are currently pending approval from the
U.S. Food and Drug Administration (FDA) and will require precertification for
Independence members once they receive FDA approval in 2019, or as of January
1, 2019, for any drug approved in 2018:
- ElzonrisTM (tagraxofusp) – Antineoplastic Agents
- ravulizumab – Miscellaneous Therapeutic Agents
- sacituzumab govitecan – Antineoplastic Agents
Lastly, all drugs that are classified by
Independence as Gene Therapy (e.g., LuxturnaTM [voretigene
neparvovec-rzyl]) will require precertification as of January 1, 2019.
These changes are reflected in an updated precertification requirement list,
which has been posted to our website.
*Precertification review is provided by CareCore
National, LLC d/b/a eviCore healthcare (eviCore), an independent company.
Precertification review benefit varies based on decision by member’s
employer group.