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
- Ilaris? (canakinumab) – Miscellaneous Therapeutic
Agents
- Jivi? (recombinant PEGylated-aucl) –
Hemophilia/Coagulation Factors
- Krystexxa? (pegloticase) – Miscellaneous Therapeutic
Agents
- LumoxitiTM (moxetumomab pasudotox-tdfk) – Antineoplastic
Agents
- PoteligeoTM (mogamulizumab-kpkc) – 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
- emapalumab – Miscellaneous Therapeutic Agents
- ravulizumab – Miscellaneous Therapeutic Agents
- sacituzumab govetican – Antineoplastic Agents
Lastly, all drugs that can be classified as Gene
Therapy (e.g., LuxturnaTM [voretigene neparvovec-rzy]) will require
precertification as of January 1, 2019.
These changes will be reflected in an updated precertification requirement
list, which will be posted to our website before the changes go into effect. The availability
of the updated precertification list will be announced in a
future Partners in Health UpdateSM article.
*Precertification review is provided by CareCore
National, LLC d/b/a eviCore healthcare (eviCore), an independent company.