Effective January 1, 2019, AmeriHealth Pennsylvania will update its
list of specialty drugs that require member cost-sharing (i.e., 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 list will be expanded to include 161 drugs, including additions of the
following:
- brexanolone*
- FulphilaTM (pegfilgrastim-jmdb)?
- Ilaris? (canakinumab)
- Jivi? (recombinant PEGylated-aucl)
- OnpattroTM (patisiran)
- ravulizumab*
- Triptodur? (triptorelin)
In addition, all specialty drugs that can be classified as Gene Therapy
(e.g., LuxturnaTM [voretigene neparvovec-rzyl]) will require member
cost-sharing.
The comprehensive list of specialty drugs with cost-sharing is now available
on our website.
*Pending approval from the U.S. Food and Drug
Administration (FDA).
?Cost-sharing applies to all FDA-approved
biosimilars to pegfilgrastim.