Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Changes to the Most Cost-Effective Setting Program

December 8, 2021

​Independence will make changes to the specialty medical benefit drugs in the Most Cost-Effective Setting Program, effective January 1, 2022.

Independence seeks to ensure that our members receive injectable/infusion therapy drugs in settings that are both safe and cost-effective. We continually review the most appropriate setting for commercial members to receive selected injectable and infusion therapy drugs eligible for coverage under the medical benefit.

Additions

Neupogen® (filgrastim) will be added to our Most Cost-Effective Setting Program. New requests for Neupogen® will require review for setting, as well as medical necessity, during the precertification process. Members who have precertification approval to receive this drug in a hospital outpatient facility may continue treatment in this setting until their current precertification approval expires. At the next precertification review, Independence will evaluate the requested setting and make a coverage determination.

Removals

Nucala® (mepolizumab) and Trogarzo® (ibalizumab-uiyk) will be removed from the Most Cost-Effective Setting Program.

Resources

For more information, including a list of all 77 drugs in the program, visit our Most Cost-Effective Setting Program webpages:


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.