As a reminder, as of 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, now require
precertification:
- Azedra® (ultratrace iobenguane I-131)* –
Antineoplastic Agents
- ElzonrisTM (tagraxofusp) – Antineoplastic Agents
- Gamifant® (emapalumab-lzsg) – Miscellaneous
Therapeutic 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
- Poteligeo® (mogamulizumab-kpkc) – Antineoplastic
Agents
- RevcoviTM (elapegademase-lvlr) – Enzyme Replacement
Agents
- TruximaTM (rituximab-abbs) – Antineoplastic Agents
- UltomirisTM (ravulizumab-cwvz) ? Miscellaneous Therapeutic
Agents
In addition, the following drug is 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: sacituzumab
govitecan – Antineoplastic Agents.
Lastly, all drugs that are classified by
Independence as Gene Therapy (e.g., LuxturnaTM [voretigene
neparvovec-rzyl]) now require precertification as of January 1, 2019.
These changes are reflected in an updated precertification requirement list,
which has been posted to our website.
*Precertification
review is provided by CareCore National, LLC d/b/a eviCore healthcare
(eviCore), an independent company. Precertification review benefit varies based
on decision by member’s employer group.