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Effective January 1, 2015, new precertification requirements will
apply to our commercial and Medicare Advantage HMO and PPO members for the
medical benefit drugs listed below.
The following medical benefit drugs will be added to the precertification
requirement list effective January 1, 2015:
- BeleodaqTM (belinostat)
- EntyvioTM (vedolizumab)
- Keytruda® (pembrolizumab)
- nivolumab (anti-PD-1 human monoclonal antibodies)*
- Ruconest® (recombinant C1-esterase inhibitor)
- SylvantTM (siltuximab)
In addition, the following medical benefit drugs will no longer require
precertification approval effective January 1, 2015:
- Aredia® (pamidronate disodium)
- Arzerra® (ofatumumab)
- Boniva® injection (ibandronate sodium)
- Ceredase® (alglucerase)
- Eloxatin® (oxaliplatin)
- Nulojix® (belatacept)
- Orthovisc® (high molecular weight hyaluronan)
- Synvisc® (hylan G-F 20)
- Synvisc-One® (hylan G-F 20)
These changes will be reflected in an updated precertification requirement
list, which will be posted to the
Preapproval/Precertification Requirements and Member Cost-Sharing page of
our website in December, prior to these changes going into effect. Look for
more information about the availability of this new precertification
requirement list in the December 2014 edition of Partners in Health
UpdateSM.
*Pending approval from the U.S. Food and Drug
Administration.