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Updated medical benefit specialty drug cost-sharing list now in effect 

January 3, 2019    

As a reminder, as of January 1, 2019, Independence has updated its list of specialty drugs that require member cost-sharing (e.g., 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 list has been expanded to include 161 drugs, including additions of the following:

  • brexanolone*
  • FulphilaTM (pegfilgrastim-jmdb)
  • Ilaris (canakinumab)
  • Jivi (recombinant PEGylated-aucl)
  • OnpattroTM (patisiran)
  • Triptodur (triptorelin)
  • UltomirisTM (ravulizumab-cwvz)

In addition, all specialty drugs that are classified by Independence as Gene Therapy (e.g., LuxturnaTM [voretigene neparvovec-rzyl]) now require member cost-sharing.

The comprehensive list of specialty drugs with cost-sharing is now available on our website.

*Pending approval from the U.S. Food and Drug Administration (FDA).

Cost-sharing applies to all FDA-approved biosimilars to pegfilgrastim.

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