As a reminder, in 2016 new precertification requirements will apply to our commercial HMO and PPO and Medicare Advantage HMO members for the following service and drugs.

Service

Bronchial thermoplasty will require precertification approval from AmeriHealth in 2016 as follows:

• Effective January 1, 2016, precertification will be required for members enrolled in Medicare Advantage plans.
• Effective March 1, 2016, precertification will be required for members enrolled in commercial plans.

Drugs

As of January 1, 2016, the medical benefit drugs listed below will require precertification approval from AmeriHealth:

• Adagen^® (pegademase bovine)
• Blincyto^® (blinatumomab)
• Cyramza^® (ramucirumab)
• Gel-Syn^™ (sodium hyaluronate)*
• GenVisc 850^® (sodium hyaluronate)*
• Imlygic^™ (talimogene laherparepvec)
• Kanuma^™ (sebelipase alfa)
• Lemtrada^® (alemtuzumab)
• Nucala^® (mepolizumab)
• VISCO-3^™ (sodium hyaluronate)
*
• Zevalin^® (ibritumomab tiuxetan)^†

These changes are reflected in updated precertification requirement lists, which are available for AmeriHealth New Jersey and for AmeriHealth Pennsylvania.

*This drug requires precertification approval as of January 1, 2016 for AmeriHealth Pennsylvania members, and as of March 1, 2016, for AmeriHealth New Jersey members.

^†Precertification review for this drug is currently provided by CareCore National, LLC d/b/a eviCore healthcare (eviCore).