Effective January 1, 2019, the following specialty drugs, which are eligible for coverage under the medical benefit for AmeriHealth New Jersey members, will require precertification:

• Azedra^? (ultratrace iobenguane I-131)* – Antineoplastic Agents
• Crysvita^? (burosumab-twza) – Miscellaneous Therapeutic Agents
• Fulphila^TM (pegfilgrastim-jmdb) – Colony Stimulating Factors
• Ilaris^? (canakinumab) – Miscellaneous Therapeutic Agents
• Ilumya^TM (tildrakizumab-asmn) – Immunological Agents
• Jivi^? (recombinant PEGylated-aucl) – Hemophilia/Coagulation Factors
• Krystexxa^? (pegloticase) – Miscellaneous Therapeutic Agents
• Lumoxiti^TM (moxetumomab pasudotox-tdfk) – Antineoplastic Agents
• Onpattro^TM (patisiran) – Miscellaneous Therapeutic Agents
• Poteligeo^TM (mogamulizumab-kpkc) – Antineoplastic Agents
• TriVisc^TM (sodium hyaluronate) – Hyaluronate Acid Products
• Trogarzo^TM (ibalizumab) – Miscellaneous Therapeutic Agents

In addition, the following drugs are currently pending approval from the U.S. Food and Drug Administration (FDA) and will require precertification for AmeriHealth New Jersey members once they receive FDA approval in 2019, or as of January 1, 2019, for any drug approved in 2018:

• cemiplimab – Anti-PD-1/PD-L1 Human Monoclonal Antibodies
• eculizumab biosimilar – Miscellaneous Therapeutic Agents
• Elzonris^TM (tagraxofusp) – Antineoplastic Agents
• emapalumab – Miscellaneous Therapeutic Agents
• ravulizumab – Miscellaneous Therapeutic Agents
• sacituzumab govetican – Antineoplastic Agents

Lastly, all drugs that can be classified as Gene Therapy (e.g., Luxturna^TM [voretigene neparvovec-rzy]) will require precertification as of January 1, 2019.

These changes will be reflected in an updated precertification requirement list, which will be posted to our website before the changes go into effect. The availability of the updated precertification list will be announced in a future Partners in Health Update^SM article.

*Precertification review is provided by CareCore National, LLC d/b/a eviCore healthcare (eviCore).