Effective July 1, 2025, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth) and AmeriHealth Administrators are updating the list of specialty drugs that require precertification under the medical benefit for members enrolled in plans administered by AmeriHealth Administrators and AmeriHealth Commercial and Medicare Advantage HMO and PPO plans.
Additions
The following drugs have been approved by the FDA and will require precertification:
- Jobevne™ – Antineoplastic agents
- Keytruda® SQ – Anti-PD-1
- Bomyntra® – Bone-modifying agents
- Conexxence® – Bone-modifying agents
- Stoboclo® – Bone-modifying agents
- Osenvelt® – Bone-modifying agents
- Ospomyv™ – Bone-modifying agents
- Xbryk™ – Bone-modifying agents
- Avtozma® – Immunological agents
- Yesintek™ – Immunological agents
- Tab-cel® – Miscellaneous therapeutic agents
- Xlucane™ – Ophthalmic agents
- Omlyclo™ – Respiratory Agents
The following drugs are pending FDA approval and will require precertification as of the date they receive FDA approval:
- Telisotuzumatelisotuzumab vedotin – Antineoplastic agents
- Vusolimogene oderparepvec – Antineoplastic agents
- Rebisufligene etisparvovec – Gene replacement/gene editing therapy
- Zopapogene imadenovec – Gene replacement/gene editing therapy
- Pegzilarginase – Enzyme replacement agents
- Nipocalimab – Myasthenia gravis agents
- Apitegromab – Miscellaneous therapeutic agents
- Copper histidinate – Miscellaneous therapeutic agents
- Deramiocel – Miscellaneous therapeutic agents
- Elamipretide – Miscellaneous therapeutic agents
- Grastofil (filgrastim-xxxx) – Neutropenia
Changes
The following drugs were added to the precertification list during a prior update cycle, in advance of their FDA approval. They have since been approved by the FDA, and the precertification list will be updated to reflect the new brand names:
- Cosibelimab will be updated to Unloxcyt™
- Datopotamab deruxtecan will be updated to Datroway®
- Eladocagene exuparvovec will be updated to Kebilidi™
Removals
The following drugs were removed from the precertification list, as they are no longer on the market.
- Beqvez™ – Gene replacement/gene editing therapies
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