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Select chemotherapy-induced nausea and vomiting drugs to require precertification

October 2, 2017

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Effective January 1, 2018, the following injectable antiemetic prophylaxis agents for chemotherapy-induced nausea and vomiting (CINV) will require precertification approval for all Independence members:

  • Emend® for injection (fosaprepitant)
  • Sustol® (granisetron extended release)
  • Cinvanti (aprepitant) ? pending FDA approval
  • Varubi® (rolapitant) ? pending FDA approval

Requests for members to begin treatment with these drugs on or after January 1, 2018, must be preapproved by Independence, in accordance with the coverage criteria listed in the Independence medical policies. Members will need to try one of the other CINV/antiemetic drugs on the formulary (e.g., palonosetron, granisetron [non-extended release formulation], ondansetron) before they will be preapproved to receive Emend, Sustol, Cinvanti, or Varubi.

Members who are on an established regimen of Emend, Sustol, Cinvanti, or Varubi prior to January 1, 2018, will not need to transition to another CINV/antiemetic drug. However, any new requests submitted for these drugs for use on or after January 1, 2018, will require precertification review from Independence.

As a reminder, there is an oral generic version of Emend that may be available under the member?s pharmacy benefit.

For more information

To learn more, Independence has created the following policies, which will be posted as Notifications on October 3, 2017, and will become effective January 1, 2018:

  • Commercial: #08.01.41: Fosaprepitant Dimeglumine (Emend®) and Granisetron (Sustol®)
  • Medicare Advantage: #MA08.091: Fosaprepitant Dimeglumine (Emend®) and Granisetron (Sustol®)

To view the Notifications for these policies, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select Commercial or Medicare Advantage under Active Notifications.

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