HomeAdministrativeBilling & ReimbursementBlueCardHealth and WellnessMedicalNaviNet OpenPharmacyProductsQuality Management


Four drugs added to Most Cost-Effective Setting Program  

January 25, 2019    

Independence seeks to ensure that our members receive injectable/infusion therapy drugs in a setting that is both safe and cost-effective. Since 2012, Independence has been reviewing the most appropriate setting for commercial members to receive certain injectable and infusion therapy drugs eligible for coverage under the medical benefit. Independence has recently added the following new-to-market drugs to our Most Cost-Effective Setting Program, on the effective dates listed below:

  • Cutaquig® (immune globulin subcutaneous [human]) – AS OF DECEMBER 12, 2018
  • Gamifant® (emapalumab-lzsg) – AS OF NOVEMBER 20, 2018
  • Udenyca™ (pegfilgrastim-cbqv) – AS OF NOVEMBER 2, 2018
  • Ultomiris™ (ravulizumab-cwvz) – AS OF DECEMBER 21, 2018

New requests for these drugs will require review for setting, as well as medical necessity, during the precertification process. Members who have precertification approval to receive these drugs 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.


Visit our Most Cost-Effective Setting Program webpage for more information, including a downloadable list of all 60 drugs on the program.

Connect with us    Facebook     Twitter     Flickr     YouTube    Walk the Talk   Independence Pinterest   Independence Google+   Independence LinkedIn   Independence InstagramSite Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2019 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.