As a reminder, as of January 1, 2019, Independence has
updated its list of specialty drugs that require member cost-sharing (e.g.,
copayment, deductible, and coinsurance). Cost-sharing applies to select medical
benefit specialty drugs for members who are enrolled in Commercial FLEX
products and other select plans. The member’s cost-sharing amount is
based on the terms of the member’s benefit contract. In accordance with
your Provider Agreement, it is the provider’s responsibility to verify a
member’s individual benefits and cost-share requirements.
The list has been expanded to include 161 drugs, including additions of the
following:
- brexanolone*
- FulphilaTM (pegfilgrastim-jmdb)†
- Ilaris? (canakinumab)
- Jivi? (recombinant PEGylated-aucl)
- OnpattroTM (patisiran)
- Triptodur? (triptorelin)
- UltomirisTM (ravulizumab-cwvz)
In addition, all specialty drugs that are classified by Independence as Gene
Therapy (e.g., LuxturnaTM [voretigene neparvovec-rzyl]) now require
member cost-sharing.
The comprehensive list of specialty drugs with cost-sharing is now available
on our website.
*Pending
approval from the U.S. Food and Drug Administration (FDA).
†
Cost-sharing applies to all FDA-approved biosimilars to
pegfilgrastim.