Independence seeks to ensure that our members receive injectable/infusion
therapy drugs in a setting that is both safe and cost-effective. Since 2012,
Independence has been reviewing the most appropriate setting for commercial
members to receive certain injectable and infusion therapy drugs eligible for
coverage under the medical benefit.
As of February 1, 2020, the following drugs were added to
our Most Cost-Effective Setting Program:
- Adakveo® (crizanlizumab-tmca)
- Avsola™ (infliximab-axxq)
- Givlaari™ (givosiran)
- Reblozyl® (luspatercept-aamt)
- Trogarzo® (ibalizumab-uiyk)
- Xembify® (immune globulin, subcutaneous human-klhw)
- Ziextenzo™ (pegfilgrastim-bmez)
New requests for these drugs will require review for setting, as well as
medical necessity, during the precertification process. Members who have
precertification approval to receive these drugs in a hospital outpatient
facility may continue treatment in this setting until their current
precertification approval expires. At the next precertification review,
Independence will evaluate the requested setting and make a coverage
determination.
Resources
Visit our Most Cost-Effective Setting Program webpage for
more information, including a downloadable list of all 70 drugs on the
program.