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As of January 1, 2017, new precertification requirements apply to
our commercial and Medicare Advantage
HMO and PPO members for the following service and drugs eligible for coverage
under the medical benefit.
Service
As of January 1, 2017, insulin pumps require precertification
approval from Independence.
Drugs
As of January 1, 2017, the drugs listed below require
precertification approval from Independence:
- Cinqair® (reslizumab)
- Cubicin® (daptomycin)
- DarzalexTM (daratumumab)
- Erwinaze® (L-asparaginase)
- Exondys 51TM (eteplirsen)
- Faslodex® (fulvestrant)
- Hymovis® (high molecular weight viscoelastic hyaluronan)
- InflectraTM (infliximab)*
- Neulasta® (pegfilgrastim)*
- Neulasta® (pegfilgrastim) Onpro®*
- Sandostatin® LAR (octreotide acetate)
- TecentriqTM (atezolizumab)
In addition, the following drugs are currently pending approval from the
U.S. Food and Drug Administration (FDA).
Once they receive FDA approval, they will also require precertification
approval from Independence:
- Cingal® (sodium hyaluronate/triamcinolone hexacetonide)
- OcrevusTM (ocrelizumab)
- Remune® (HIV-1 immunogen)
These changes are reflected in an updated precertification requirement list,
which is posted to our website.
*Precertification requirements apply to all biosimilars
of infliximab and pegfilgrastim approved by the FDA.
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