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Updates to the list of specialty drugs that require precertification

May 10, 2018

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.


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