Effective January 1, 2019, the following specialty drugs, which are
eligible for coverage under the medical benefit for Independence commercial and
Medicare Advantage HMO and PPO members, will require precertification:
- Azedra? (ultratrace iobenguane I-131)* ? Antineoplastic
Agents
- Ilaris? (canakinumab) ? Miscellaneous Therapeutic Agents
- Jivi? (recombinant PEGylated-aucl) ? Hemophilia/Coagulation
Factors
- Krystexxa? (pegloticase) ? Miscellaneous Therapeutic Agents
- LumoxitiTM (moxetumomab pasudotox-tdfk) ? Antineoplastic
Agents
- Panzyga? (immunoglobulin intravenous [human]) ? IVIG/SCIG ?
RECENT ADDITION
- PoteligeoTM (mogamulizumab-kpkc) ? Antineoplastic Agents
- RevcoviTM (elapegademase-lvlr) ? Enzyme Replacement Agents ?
RECENT ADDITION
In addition, the following drugs are currently pending approval from the
U.S. Food and Drug Administration (FDA) and will require precertification for
Independence members once they receive FDA approval in 2019, or as of January
1, 2019, for any drug approved in 2018:
- ElzonrisTM (tagraxofusp) ? Antineoplastic Agents
- emapalumab ? Miscellaneous Therapeutic Agents
- ravulizumab ? Miscellaneous Therapeutic Agents
- sacituzumab govitecan ? Antineoplastic Agents
Lastly, all drugs that are classified by Independence as Gene
Therapy (e.g., LuxturnaTM [voretigene neparvovec-rzyl]) will require
precertification as of January 1, 2019.
These changes will be reflected in an updated precertification requirement
list, which will be posted to our website before the changes go into effect. The availability
of the updated precertification list will be announced in a future Partners
in Health UpdateSM article.
*Precertification review is provided by CareCore
National, LLC d/b/a eviCore healthcare (eviCore), an independent company.