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Effective January 1, 2017, new precertification requirements will
apply to our commercial HMO and PPO members
for the following services and drugs eligible for coverage under the medical
benefit.
Services
As of January 1, 2017, insulin pumps will require precertification
approval from AmeriHealth.
As of January 1, 2017, applied behavioral analysis for treatment of
autism spectrum disorders will require
precertification approval from AmeriHealth New Jersey. Please note that this
precertification review is provided by
Magellan Healthcare, Inc.
Drugs
As of January 1, 2017, the drugs listed below will require
precertification approval from AmeriHealth:
- Cinqair® (reslizumab)
- Cubicin® (daptomycin)
- DarzalexTM (daratumumab)
- Erwinaze® (L-asparaginase)
- Exondys 51TM (eteplirsen)
- Faslodex® (fulvestrant)
- Hymovis® (high molecular weight viscoelastic hyaluronan)
- InflectraTM (infliximab)*
- Neulasta® (pegfilgrastim)*
- Neulasta® (pegfilgrastim) Onpro®*
- Sandostatin® LAR (octreotide acetate)
- TecentriqTM (atezolizumab)
In addition, the following drugs are currently pending approval from the
U.S. Food and Drug Administration (FDA).
Once they receive FDA approval, they will also require precertification
approval from AmeriHealth:
- Cingal® (sodium hyaluronate/triamcinolone hexacetonide)
- OcrevusTM (ocrelizumab)
- Remune® (HIV-1 immunogen)
These changes will be reflected in an updated precertification requirement
list, which will be posted on our AmeriHealth New Jersey website or AmeriHealth Pennsylvania website later this month, prior to
these changes going into effect.
*Precertification requirements apply to all biosimilars
of infliximab and pegfilgrastim approved by the FDA.
Magellan Healthcare, Inc. manages mental health and
substance abuse benefits for most AmeriHealth members.