As a reminder, in 2016 new precertification requirements will apply to our
commercial and Medicare Advantage HMO and PPO members for the following service
and drugs.
Service
Bronchial thermoplasty will require precertification approval from
Independence in 2016 as follows:
- Effective January 1, 2016, precertification will be required for
members enrolled in Medicare Advantage plans.
- Effective March 1, 2016, precertification will be required for
members enrolled in commercial plans.
Drugs
As of January 1, 2016, the medical benefit drugs listed below will
require precertification approval from Independence:
- Adagen® (pegademase bovine)
- Blincyto® (blinatumomab)
- Cyramza® (ramucirumab)
- Gel-Syn™ (sodium hyaluronate)
- GenVisc 850® (sodium hyaluronate)
- Imlygic™ (talimogene laherparepvec)
- Kanuma™ (sebelipase alfa)
- Lemtrada® (alemtuzumab)
- Nucala® (mepolizumab)
- VISCO-3™ (sodium hyalrunate)
- Zevalin® (ibritumomab tiuxetan)*
These changes are reflected in an updated precertification requirement list.
*Precertification review for this drug is currently
provided by CareCore National, LLC d/b/a eviCore healthcare (eviCore), an
independent company.