Effective January 1, 2021, the following policies will be archived because the precertification requirement for the applicable drugs will be removed:
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Commercial: #08.01.19f: Siltuximab (Sylvant®)
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Medicare Advantage: MA08.006f: Siltuximab (Sylvant®)
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The code J2860 Injection, siltuximab, 10 mg is eligible for coverage.
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Commercial: #08.00.98e: Eribulin Mesylate (Halaven®)
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Medicare Advantage: MA08.056c: Eribulin Mesylate (Halaven®)
- The code J9179 Injection, eribulin mesylate, 0.1 mg is eligible for coverage.
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Commercial: #08.00.96e: Cabazitaxel (Jevtana®)
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Medicare Advantage: MA08.054c: Cabazitaxel (Jevtana®)
- The code J9043 Injection, Cabazitaxel, 1 mg is eligible for coverage.
Changes to the precertification requirement list that become effective January 1, 2021, are posted on our
website.
Effective January 1, 2021, the following policies will be archived because the information in these policies is now addressed in our Cosmetic Procedures policies #12.01.03a for Commercial products and #MA12.009a for Medicare Advantage products:
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Commercial: #08.01.24a: Deoxycholic Acid (KybellaTM)
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Medicare Advantage: MA08.074a: Deoxycholic Acid (KybellaTM)
Effective January 4, 2021, the following policies will be archived:
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Commercial: #08.00.88f: Ofatumumab (Arzerra®)
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Medicare Advantage: MA08.048d: Ofatumumab (Arzerra®)
Precertification information on the above policies was previously communicated in a Partners in Health UpdateSM article.