Starting June 15, 2018, the following specialty drugs, which are
eligible for coverage under the medical benefit, will require precertification
for Independence commercial and Medicare Advantage HMO and PPO members:
- Crysvita? (burosumab-twza)
- IlumyaTM
(tildrakizumab-asmn)
- TrogarzoTM (ibalizumab-uiyk)
Note: Independence?s medical policies for these drugs are
currently in development. Until these policies are published, precertification
review for these drugs will be based on the U.S. Food and Drug Administration
(FDA)-approved indication.
In addition, a biosimilar for the drug Soliris? (eculizumab) is
pending approval from the FDA. This drug will require precertification from
Independence upon FDA approval.
These changes will be reflected in an updated precertification requirement
list, which will be posted to our website before the changes go into effect. The availability
of the updated precertification list will be announced in a future Partners
in Health UpdateSM article.