As a reminder, as of January 1, 2019, the following specialty drugs, which are eligible for coverage under the medical benefit for Independence commercial and Medicare Advantage HMO and PPO members, now require precertification:
- Azedra® (ultratrace iobenguane I-131)* – Antineoplastic Agents
- ElzonrisTM (tagraxofusp) – Antineoplastic Agents
- Gamifant® (emapalumab-lzsg) – Miscellaneous Therapeutic Agents
- Ilaris® (canakinumab) – Miscellaneous Therapeutic Agents
- Jivi® (recombinant PEGylated-aucl) – Hemophilia/Coagulation Factors
- Krystexxa® (pegloticase) – Miscellaneous Therapeutic Agents
- LumoxitiTM (moxetumomab pasudotox-tdfk) – Antineoplastic Agents
- Panzyga® (immunoglobulin intravenous [human]) – IVIG/SCIG
- Poteligeo® (mogamulizumab-kpkc) – Antineoplastic Agents
- RevcoviTM (elapegademase-lvlr) – Enzyme Replacement Agents
- TruximaTM (rituximab-abbs) – Antineoplastic Agents
- UltomirisTM (ravulizumab-cwvz) – Miscellaneous Therapeutic Agents
In addition, the following drug is currently pending approval from the U.S. Food and Drug Administration (FDA) and will require precertification for Independence members once they receive FDA approval in 2019: sacituzumab govitecan – Antineoplastic Agents.
Lastly, all drugs that are classified by Independence as Gene Therapy (e.g., LuxturnaTM [voretigene neparvovec-rzyl]) now require precertification as of January 1, 2019.
These changes are reflected in an updated precertification requirement list, which has been posted to our website.
*Precertification review is provided by CareCore National, LLC d/b/a eviCore healthcare (eviCore), an independent company. Precertification review benefit varies based on decision by member’s employer group.