Effective July 1, 2019, AmeriHealth Pennsylvania will update its list of specialty drugs that require member cost-sharing (e.g., copayment, deductible, and coinsurance). Cost-sharing applies to select medical benefit specialty drugs for members who are enrolled in Commercial FLEX products and other select plans. The member’s cost-sharing amount is based on the terms of the member’s benefit contract. In accordance with your Provider Agreement, it is the provider’s responsibility to verify a member’s individual benefits and cost-share requirements.

The cost-share list will be expanded to include 170 drugs, with the following additions:

• Asceniv^TM (immune globulin intravenous, human-slra)
• Brixadi^TM (buprenorphine)
• Cutaquig^® (immunoglobulin [human], subcutaneous)
• Esperoct^® (antihemophilic factor [recombinant], glycopegylated-exei)
• Evenity^TM (romosozumab-aqqg)
• Lupaneta^TM (leuprolide acetate for depot suspension and norethindrone acetate tablets)
• Lutrate^® (leuprolide acetate for depot suspension)
• Panzyga^® (immunoglobulin intravenous [human])
• Ryplazim^TM (plasminogen)*
• Scenesse^® (afamelanotide)* 
• Udenyca^® (pegfilgrastim-cbqv)
• Yutiq^TM (fluocinolone acetonide intravitreal implant)
• Zolgensma^® (onasemnogene abeparvovec-xxxx)*

The following drugs were moved from the Miscellaneous Therapeutic Agents category on the cost-share list and reclassified as Substance Use Disorder Agents:

• Probuphine^® (buprenorphine)
• Sublocade^TM (buprenorphine extended-release)
• Vivitrol^® (naltrexone for extended-release injectable suspension)

The following drugs received approval from the U.S. Food and Drug Administration (FDA) after the cost-share list was last published in 2018. The list will be updated to reflect their FDA-approved brand names:

• brexanolone will become Zulresso
• ravulizumab will become Ultomiris^TM

The updated list of specialty drugs with cost-sharing will be available on our website later this month.

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