Effective January 1, 2016, new precertification requirements will apply to our commercial HMO and PPO and Medicare Advantage HMO members for the eight medical benefit drugs listed below:

• Adagen^® (pegademase bovine)
• Blincyto^® (blinatumomab)
• Cyramza^® (ramucirumab)
• Imlygic? (talimogene laherparepvec)
• Kanuma? (sebelipase alfa)*
• Lemtrada^® (alemtuzumab)
• mepolizumab*
• Zevalin^® (ibritumomab tiuxetan)^†

These changes will be reflected in an updated precertification requirement list, which will be posted on the AmeriHealth New Jersey website and the AmeriHealth Pennsylvania website in December, prior to these changes going into effect.

In addition, Notifications for new medical policies for Adagen (pegademase bovine) and Cyramza (ramucirumab) will be available in December.

Coverage for off-label use

The medical necessity criteria for these drugs are based on the U.S. Food and Drug Administration (FDA)-labeled indications. Coverage for off-label use of these drugs may be provided in accordance with the following policies:

• Commercial: #08.00.15c: Off-label Coverage for Prescription Drugs and Biologics
• Medicare Advantage: #MA08.012: Off-label Coverage for Prescription Drugs and/or Biologics

To view these policies, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select Commercial or Medicare Advantage depending on the version of the policy you?d like to view.

Look for more information about the availability of the new precertification requirement list in the December 2015 edition of Partners in Health Update^SM.

*Pending approval from the U.S. Food and Drug Administration

^†Precertification review for this drug is currently provided by CareCore National, LLC d/b/a eviCore healthcare (eviCore) for AmeriHealth Pennsylvania HMO members. Precertification for this drug will be reviewed by eviCore starting January 1, 2016, for all AmeriHealth New Jersey members.