AmeriHealth New Jersey seeks to ensure that our members receive
injectable/infusion therapy drugs in a setting that is both safe and
cost-effective. Since 2012, AmeriHealth New Jersey has been reviewing the most
appropriate setting for members to receive certain injectable and infusion
therapy drugs eligible for coverage under the medical benefit.
AmeriHealth New Jersey will add the following drugs to our Most
Cost-Effective Setting Program, on the effective dates listed below:
- IlumyaTM (tildrakizumab-asmn) ? January 1, 2019
- Kanuma? (sebelipase alfa) ? November 1, 2018
- Panzyga? (immunoglobulin intravenous ([human]) ? January 1, 2019
- RevcoviTM (elapegademase-lvlr) ? January 1, 2019
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 New Jersey 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.