Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Updated list of specialty drugs that require precertification now in effect

January 3, 2019

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.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.