Effective July 1, 2019, the following specialty drugs,
which are eligible for coverage under the medical benefit for AmeriHealth
Pennsylvania members, will require precertification:
- Asceniv™ (immune globulin intravenous, human-slra, 10% liquid)
– Intravenous/Subcutaneous Immune Globulin (IVIG/SCIG)
- Evenity™ (romosozumab-aqqg) – Bone-Modifying Agents
- Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk) –
Antineoplastic Agents
- Trazimera™ (trastuzumab-qyyp) – Antineoplastic Agents
In addition, the gene therapy drug
Zolgensma® was updated to reflect its approval
by the U.S. Food and Drug Administration (FDA) on May 24, 2019. Medical
policies are currently in development to address these drugs. In lieu of
published policies, requests for these drugs will be subject to FDA-approved
indications and guidelines.
These changes will be reflected in an updated precertification requirement
list, which will be posted to our website.