As a reminder, effective January 1, 2019, Independence
will update its list of specialty drugs that require member cost-sharing (e.g.,
copayment, deductible, and coinsurance). Cost-sharing applies to select medical
benefit specialty drugs for members who are enrolled in Commercial FLEX
products and other select plans. The member’s cost-sharing amount is
based on the terms of the member’s benefit contract. In accordance with
your Provider Agreement, it is the provider’s responsibility to verify a
member’s individual benefits and cost-share requirements.
The list will be expanded to include 161 drugs, including additions of the
following:
- brexanolone*
- FulphilaTM (pegfilgrastim-jmdb)†
- Ilaris® (canakinumab)
- Jivi® (recombinant PEGylated-aucl)
- OnpattroTM (patisiran)
- ravulizumab*
- Triptodur® (triptorelin)
In addition, all specialty drugs that are classified by Independence as Gene
Therapy (e.g., LuxturnaTM [voretigene neparvovec-rzyl]) will require
member cost-sharing.
The comprehensive list of specialty drugs with cost-sharing is now available
on our website.
*Pending approval from the U.S. Food and Drug
Administration (FDA).
†Cost-sharing applies to all
FDA-approved biosimilars to pegfilgrastim.