Effective July 5, 2016, ipilimumab (Yervoy®)
will be added to the Dosing and Frequency Program.
Since January 1, 2011, Independence has reviewed the dosing and frequency of
administration for select drugs as
part of the precertification process. With the addition of
Yervoy® to this program, the drugs that will be reviewed for
dosing and frequency are:
- bevacizumab (Avastin®)*
- cetuximab (Erbitux®)
- immune globulin, intravenous/subcutaneous (IVIG/SCIG)
- infliximab (Remicade®)
- ipilimumab (Yervoy®)
- onabotulinumtoxinA (Botox®)
- rituximab (Rituxan®)
- trastuzumab (Herceptin®)
Independence reserves the right to conduct a post-payment review and audit
of claims submitted for any drug that
is part of the Dosing and Frequency Program and may recover payments made in
excess of the amount approved
through the precertification process. For more information on guidelines for
the Dosing and Frequency Program,
please refer to the specific medical policies for each drug included in the
program.
Adjuvant Patient Program for Melanoma
Providers should be aware that Bristol-Myers Squibb, an independent company
and the manufacturer of Yervoy®, offers a patient assistance
program called the Adjuvant Patient Program for Melanoma. This program is
available for individuals, whether insured or uninsured, who are undergoing
adjuvant treatment of fully resected Stage III
melanoma (lymph node >1 mm).
Providers should contact Bristol-Myers Squibb to enroll their Independence
patients in this program if they are requesting the 10 mg/kg dose for the
adjuvant treatment of fully resected Stage III melanoma. Enrollment in this
program may yield savings for these individuals. Eligible individuals may
receive Yervoy® free of charge for the duration of treatment,
which may be up to three years. Providers who administer Yervoy®
to members enrolled in this program should not
submit reimbursement claims for Yervoy®, as the drug is being
supplied at no cost to the provider; however, providers should continue to
submit claims for administration of the drug and for any other services
rendered during the visit. Eligibility in this program is determined by the
drug manufacturer. More information about the program is available from
Bristol-Myers Squibb Access Support® at
1-800-861-0048 or on their website.
Providers can also find additional information about this program in the
following Independence medical policies,
which will be available on July 5, 2016:
- Commercial: #08.01.01e: Ipilimumab (Yervoy®)
- Medicare Advantage: #MA08.059b: Ipilimumab
(Yervoy®)
To access medical policies, visit our Medical Policy Portal. Select
Accept and Go to
Medical Policy Online, then select Commercial or Medicare
Advantage, depending on which version of the policy you?d like to view, and
then type the name or policy number in the Search field. To access medical
policies from
Independence NaviNet® Plan Central, select Medical Policy
Portal under Provider Tools in the right hand column.
Please call 1-800-ASK-BLUE if you have any questions about
the precertification process for Yervoy® or any other drugs
included in the Dosing and Frequency Program.
* Only oncology requests for bevacizumab
(Avastin®) require precertification approval for dosing and
frequency. Requests for intravitreal injection of bevacizumab (Avastin®) to treat the ophthalmologic
conditions listed in this drug?s medical policy do not require
precertification.
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