IBC wants to ensure that our members receive drug therapy in a setting that is
both cost-effective and safe for their clinical condition. Since January 1,
2012, IBC has considered the setting where commercial members can receive
Ceredase
® (alglucerase), Cerezyme
®
(imiglucerase), Soliris
® (eculizumab), and VPRIV
®
(velaglucerase alfa).
Effective July 1, 2012, as part of the precertification review process, IBC
will consider the setting where eight additional infusion therapy drugs can be
administered:
Aralast NP (alpha-1 proteinase inhibitor [human])
Elelyso
® (taliglucerase alfa)
Fabrazyme
® (agalsidase beta)
Glassia (alpha-1 proteinase inhibitor [human])
Lumizyme
® (alglucosidase alfa)
Myozyme
® (alglucosidase alfa)
Prolastin
® (alpha-1 proteinase inhibitor [human])
Zemaira
® (alpha-1 proteinase inhibitor [human])
These drugs will continue to be covered by IBC for members who meet the
clinical criteria outlined in our medical policies, but only when the drugs are
administered in the setting that is approved by IBC during the precertification
review process.
During this process, each member's unique medical needs and clinical history
will be considered to determine which setting will be approved to receive drug
therapy. IBC will also review any black box warning included in the prescribing
information at the time that precertification for the drug is requested. If
there are clinical circumstances that require a member to receive one of these
drugs in an outpatient facility, the provider must submit documentation to IBC
that specifically addresses these clinical circumstances when submitting a
request for coverage.
To review the medical policies for the drugs listed, go to our
Medical Policy website and type the
name of the drug in the Search box.