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Download the latest precertification requirement list

January 9, 2014

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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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