Effective July 1, 2025, 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 the following additions:
- Kebilidi™ – Gene replacement/gene editing therapies
- Rebisufligene etisparvovec – Gene replacement/gene editing therapies
- Zopapogene imadenovec – Gene replacement/gene editing therapies
- Hympavzi™ – Hemophilia/Coagulation Factors
- Qfitlia® – Hemophilia/Coagulation Factors
- Avtozma® – Immunological Agents
- Imuldosa™ – Immunological Agents
- Yesintek™ – Immunological Agents
- Apitegromab – Miscellaneous therapeutic agents
- Copper histidinate – Miscellaneous therapeutic agents
- Deramiocel – Miscellaneous therapeutic agents
An updated medical benefit specialty drug cost-share list will be available on our website prior to July 1, 2025.
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