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Effective January 1, 2018, Independence will make the changes
detailed below to specialty drugs requiring precertification under the medical
benefit.
Additions
New precertification requirements will apply to Independence commercial and
Medicare Advantage HMO and PPO members for the following specialty drugs as of
January 1, 2018:
- Mvasi™ (bevacizumab-awwb)
- Radicava™ (edaravone)
- Somatuline® Depot (lanreotide)
- Sustol® (granisetron extended release)
In addition, the following drugs are currently pending approval from the
U.S. Food and Drug Administration (FDA). These drugs will require
precertification from Independence once they receive FDA approval in 2018, or
on January 1, 2018, for any drug approved in 2017:
- Exenatide sustained-release ITCA 650
- Herceptin® (trastuzumab) biosimilar
- Luxturna™ (voretigene neparvovec)
- Neulasta® (pegfilgrastim) biosimilar
- Rituxan® (rituximab) biosimilar
Deletions
The following drugs will no longer require precertification from
Independence as of January 1, 2018:
- Berinert® (C1 esterase inhibitor [human])*
- Cinryze® (C1 esterase inhibitor [human])*
- Cubicin® (daptomycin)
- Faslodex® (fulvestrant)
- Kalbitor® (ecallantide)
- Myozyme® (alglucosidase alfa)
- Ruconest® (C1 esterase inhibitor recombinant)*
- Synribo® (omacetaxine mepesuccinate)
These changes will be reflected in an updated precertification requirement
list, which will be posted to our website prior to these changes going into
effect. The availability of the updated precertification requirement list will
be announced in a future Partners in Health UpdateSM
article.
Please note: In a previously published version of this article,
Independence stated that the drugs Emend® for injection
(fosaprepitant), Cinvanti™ (aprepitant), and
Varubi® (rolapitant) would require precertification approval
effective January 1, 2018. Based on provider feedback, Independence has
reconsidered this position. Therefore, these three drugs will not
require precertification approval.
*Effective January 1, 2018, these drugs will no longer be
eligible for coverage under the medical benefit. As self-administered drugs,
they will now be eligible for coverage under the pharmacy benefit for members
with Independence prescription drug coverage. Members who do not have
prescription drug coverage through Independence should contact their pharmacy
benefits manager to determine if coverage for these self-administered drugs is
available.
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