Effective July 7, 2024, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth) will update their list of specialty drugs that require member cost-sharing (i.e., 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 updated cost-share list will include 221 drugs, with the following additions:
- Tyenne® – Immunological Agents
- Selarsdi™ – Immunological Agents
- Prademagene zamikeracel – Gene Replacement/Gene Editing Therapies
- imetelstat – Miscellaneous therapeutic agents
- marstacimab – Miscellaneous therapeutic agents
- Alyglo™ – IVIG
- Udenyca OnBody™ – Neutropenia
- marnetegragene autotemcel – Gene Replacement/Gene Editing Therapies
The following drugs were added to the cost-share list during a previous update cycle, prior to receiving FDA approval. These drugs have since received FDA approval, and their brand names have changed as follows:
- debamestrocel will be changed to NurOwn® – Amyotrophic Lateral Sclerosis Agents
- fidanacogene elaparvovec will be changed to Beqvez™ – Gene Replacement/Gene Editing Therapies
- atidarsagene autotemcel will be changed to Lenmeldy™ – Gene Replacement/Gene Editing Therapies
An updated medical benefit specialty drug cost-share list will be available on our website prior to July 1, 2024.