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Effective January 1, 2017, new precertification requirements will
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 will require precertification
approval from Independence.
Drugs
As of January 1, 2017, the drugs listed below will 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 will be reflected in an updated precertification requirement
list, which will be posted to our website later this month, prior to these changes
going into effect.
*Precertification requirements apply to all biosimilars
of infliximab and pegfilgrastim approved by the FDA.