AmeriHealth seeks to ensure that our members receive injectable/infusion
therapy drugs in a setting that is both safe and cost-effective. Since 2012,
AmeriHealth has been reviewing the most appropriate setting for members to
receive certain injectable and infusion therapy drugs eligible for coverage
under the medical benefit.
As of November 1, 2018, AmeriHealth added the following drugs to our
Most Cost-Effective Setting Program:
- IlumyaTM (tildrakizumab-asmn)
- Kanuma? (sebelipase alfa)
- Panzyga? (immunoglobulin intravenous [human])
- RevcoviTM (elapegademase-lvlr)
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,
AmeriHealth will evaluate the requested setting and make a coverage
determination.
Resources
Visit our Most Cost-Effective Setting Program webpage
for more information, including a downloadable list of all 56 drugs on the
program.