As of July 1, 2018, AmeriHealth Pennsylvania updated
its 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-sharing amounts.
The list has been expanded to include 155 drugs, including additions for the
following drugs:
- Crysvita? (burosumab-twza)
- IlumyaTM (tildrakizumab-asmn)
- TrogarzoTM (ibalizumab-uiyk)
- Eculizumab biosimilar
The comprehensive list of specialty drugs with cost-sharing is available on
our website.