Effective July 1, 2019, Independence will update 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 cost-share list will be expanded to include 170 drugs, with the
following additions:
- AscenivTM (immune globulin intravenous, human-slra)
- BrixadiTM (buprenorphine)
- Cutaquig® (immunoglobulin [human], subcutaneous)
- Esperoct® (antihemophilic factor [recombinant],
glycopegylated-exei)
- EvenityTM (romosozumab-aqqg)
- LupanetaTM (leuprolide acetate for depot suspension and
norethindrone acetate tablets)
- Lutrate® (leuprolide acetate for depot suspension)
- Panzyga® (immunoglobulin intravenous [human])
- RyplazimTM (plasminogen)*
- Scenesse® (afamelanotide)*
- Udenyca® (pegfilgrastim-cbqv)
- YutiqTM (fluocinolone acetonide intravitreal implant)
- Zolgensma® (onasemnogene abeparvovec-xxxx)*
The following drugs were moved from the Miscellaneous Therapeutic Agents
category on the cost-share list and reclassified as Substance Use Disorder
Agents:
- Probuphine® (buprenorphine)
- SublocadeTM (buprenorphine extended-release)
- Vivitrol® (naltrexone for extended-release injectable
suspension)
The following drugs received approval from the U.S. Food and Drug
Administration (FDA) after the cost-share list was last published in 2018. The
list will be updated to reflect their FDA-approved brand names:
- brexanolone will become Zulresso
- ravulizumab will become UltomirisTM
The updated list of specialty drugs with cost-sharing will be available on
our website later this month.
*Pending approval from the U.S. Food and Drug
Administration (FDA).