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Effective January 1, 2014, IBC uses a single precertification
requirement list across all managed care products. This change was
made as we continue to look for ways to improve and simplify the
precertification process.
For the most up-to-date list of services and specialty drugs that require
precertification, download the latest version of the precertification
requirement list from our website.
As a reminder, significant changes went into effect January 1, 2014, for
the following three categories:
- Outpatient surgical procedures. For standard HMO products,
only
select outpatient surgical procedures require precertification.
- Durable medical equipment (DME) and prosthetic items. The
precertification requirement list has been updated to specify only
certain DME and prosthetic items that require precertification,
regardless of the cost of these items.
- Injectable and infusion therapy drugs. Precertification
approval
has been added for Acthar H.P.?, Adcetris?,
Kyprolis?, Naglazyme?,
Perjeta?, Simponi? Aria, Veletri?, and
Xofigo?. Precertification is no
longer required for Lucentis?, Macugen?, Mozobil?, and Temodar?. In
addition, precertification requirements for 23 drugs have been removed
for members who have Flex products. These drugs include Aranesp?,
Neulasta?, and Eligard?.
If you have any questions, please contact Cheryl McGurk, Manager of
Precertification, at 215-241-4542.
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