As a reminder, effective January 1, 2019, the following specialty drugs, which are eligible for coverage under the medical benefit for AmeriHealth Pennsylvania members, will require precertification:

• Azedra^? (ultratrace iobenguane I-131)* – Antineoplastic Agents
• Gamifant^? (emapalumab-lzsg) – Miscellaneous Therapeutic Agents
• Ilaris^? (canakinumab) – Miscellaneous Therapeutic Agents
• Jivi^? (recombinant PEGylated-aucl) – Hemophilia/Coagulation Factors
• Krystexxa^? (pegloticase) – Miscellaneous Therapeutic Agents
• Lumoxiti^TM (moxetumomab pasudotox-tdfk) – Antineoplastic Agents
• Panzyga^? (immunoglobulin intravenous [human]) – IVIG/SCIG
• Poteligeo^? (mogamulizumab-kpkc) – Antineoplastic Agents
• Revcovi^TM (elapegademase-lvlr) – Enzyme Replacement Agents
• Truxima^TM (rituximab-abbs) – Antineoplastic Agents

In addition, the following drugs are currently pending approval from the U.S. Food and Drug Administration (FDA) and will require precertification for AmeriHealth Pennsylvania members once they receive FDA approval in 2019, or as of January 1, 2019, for any drug approved in 2018:

• Elzonris^TM (tagraxofusp) – Antineoplastic Agents
• ravulizumab – Miscellaneous Therapeutic Agents
• sacituzumab govitecan – Antineoplastic Agents

Lastly, all drugs that are classified by AmeriHealth as Gene Therapy (e.g., Luxturna^TM [voretigene neparvovec-rzyl]) will require precertification as of January 1, 2019.

These changes are reflected in an updated precertification requirement list, which has been posted to our website.

*Precertification review is provided by CareCore National, LLC d/b/a eviCore healthcare (eviCore). Precertification review benefit varies based on decision by member’s employer group.