Effective January 1, 2018, AmeriHealth will make the changes detailed below to specialty drugs requiring precertification under the medical benefit.

Additions

New precertification requirements will apply to AmeriHealth members for the following specialty drugs as of January 1, 2018:

1. Mvasi^™ (bevacizumab-awwb)
2. Radicava^™ (edaravone)
3. Somatuline^® Depot (lanreotide)
4. Sustol^® (granisetron extended release)

In addition, the following drugs are currently pending approval from the U.S. Food and Drug Administration (FDA). These drugs will require precertification from AmeriHealth once they receive FDA approval in 2018, or on January 1, 2018, for any drug approved in 2017:

• Exenatide sustained-release ITCA 650
• Herceptin^® (trastuzumab) biosimilar
• Luxturna^™ (voretigene neparvovec)
• Neulasta^® (pegfilgrastim) biosimilar
• Rituxan^® (rituximab) biosimilar

Deletions

The following drugs will no longer require precertification from AmeriHealth as of January 1, 2018:

• Berinert^® (C1 esterase inhibitor [human])*
• Cinryze^® (C1 esterase inhibitor [human])*
• Cubicin^® (daptomycin)
• Faslodex^® (fulvestrant)
• Kalbitor^® (ecallantide)
• Myozyme^® (alglucosidase alfa)
• Ruconest^® (C1 esterase inhibitor recombinant)*
• Synribo^® (omacetaxine mepesuccinate)

These changes will be reflected in an updated precertification requirement list, which will be posted to the AmeriHealth New Jersey and AmeriHealth Pennsylvania websites prior to these changes going into effect. The availability of the updated precertification requirement list will be announced in a future Partners in Health Update^SM article.

Please note: In a previously published version of this article, AmeriHealth stated that the drugs Emend^® for injection (fosaprepitant), Cinvanti^™ (aprepitant), and Varubi^® (rolapitant) would require precertification approval effective January 1, 2018. Based on provider feedback, AmeriHealth has reconsidered this position. Therefore, these three drugs will not require precertification approval.

*Effective January 1, 2018, these drugs will no longer be eligible for coverage under the medical benefit. As self-administered drugs, they will now be eligible for coverage under the pharmacy benefit for members with AmeriHealth prescription drug coverage. Members who do not have prescription drug coverage through AmeriHealth should contact their pharmacy benefits manager to determine if coverage for these self-administered drugs is available.