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Updates to the list of specialty drugs that will require precertification

June 3, 2019

Effective July 1, 2019, the following specialty drugs, which are eligible for coverage under the medical benefit for Independence commercial and Medicare Advantage HMO and PPO members, will require precertification:

  • Asceniv™ (immune globulin intravenous, human-slra, 10% liquid) – Intravenous/Subcutaneous Immune Globulin (IVIG/SCIG)
  • Evenity™ (romosozumab-aqqg) – Bone-Modifying Agents
  • Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk) – Antineoplastic Agents
  • Trazimera™ (trastuzumab-qyyp) – Antineoplastic Agents

In addition, the gene therapy drug Zolgensma® was updated to reflect its approval by the U.S. Food and Drug Administration (FDA) on May 24, 2019. Medical policies are currently in development to address these drugs. In lieu of published policies, requests for these drugs will be subject to FDA-approved indications and guidelines.

These changes will be reflected in an updated precertification requirement list, which will be posted to our website.


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