As a reminder, as of July 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, require precertification:
- Asceniv™ (immune globulin intravenous, human-slra, 10% liquid) – Intravenous/Subcutaneous Immune Globulin (IVIG/SCIG)
- Evenity™ (romosozumab-aqqg) – Bone-Modifying Agents
- Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk) – Antineoplastic Agents
- Trazimera™ (trastuzumab-qyyp) – Antineoplastic Agents
In addition, the gene therapy drug Zolgensma® (onasemnogene abeparvovec-xioi) was updated to reflect its approval by the U.S. Food and Drug Administration (FDA) on May 24, 2019.
Updated policies
The following policies have been updated to include Asceniv:
- Commercial: 08.00.13u: Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
- Medicare Advantage: MA08.009g: Immune Globulin: Intravenous (IVIG), Subcutaneous (SCIG)
Medical policies for all other drugs are currently in development. In lieu of published policies, requests for these drugs will be subject to FDA-approved indications and guidelines. To access medical policies, visit our Medical Policy Portal.
These changes are reflected in an updated precertification requirement list, posted on our website.