Effective January 1, 2014, IBC will use a single precertification
requirement list across all managed care products. This change is being made as
we continue to look for ways to improve and simplify the precertification
process.
Significant changes will be made to the precertification requirements for the
following three categories effective January 1, 2014:
Outpatient surgical procedures. For standard HMO products, not all
outpatient surgical procedures will require precertification. Only select
outpatient surgical procedures will be included on the precertification
requirement list.
Durable medical equipment (DME) and prosthetic items. Currently,
precertification is required for all rentals and purchases of DME and
prosthetic items that cost more than $500. Effective January 1, 2014, only
certain DME and prosthetic items will require precertification, regardless of
the cost of these items.
Injectable and infusion therapy drugs. Precertification requirements
will be added for Acthar H.P.
®, Adcetris
®,
Kyprolis
®, Naglazyme
®, Perjeta
®,
Simponi
® Aria, Veletri
®, and
Xofigo
®. Precertification approval will no longer be required
for Lucentis
®, Macugen
®, Mozobil
®,
and Temodar
®. In addition, precertification requirements for 23
drugs will be removed for members who have Flex products. The drugs include
Aranesp
®, Neulasta
®, and Eligard
®.
These changes are reflected on the precertification requirement list available
on our
Preapproval/Precertification
for Services web page.
If you have any questions, please contact Cheryl McGurk, Manager of
Precertification, at
215-241-4542.