AmeriHealth New Jersey will make several updates to the list of specialty drugs that require precertification review, which are eligible for coverage under the medical benefit for AmeriHealth New Jersey members.
Additions for biosimilars
The following biosimilars were recently approved by the U.S. Food and Drug Administration (FDA) and will require precertification approval
effective June 3, 2019:
- Herzuma® (trastuzumab-pkrb) – Antineoplastic Agents
- Ontruzant® (trastuzumab-dttb) – Antineoplastic Agents
- Truxima™ (rituximab-abbs) – Antineoplastic Agents
- Udenyca™ (pegfilgrastim-cbqv) – Colony-Stimulating Factors
Udenyca™ to be added to the Most Cost-Effective Setting Program
Effective June 3, 2019, Udenyca™ (pegfilgrastim-cbqv) will be added to the Most Cost-Effective Setting Program. To access the complete list of drugs in the program, please visit our
Most Cost-Effective Setting Program webpage.
Gene therapy
The following gene therapy drug is expected to receive FDA approval in the coming months for the treatment of spinal muscular atrophy: Zolgensma* (onasemnogene abeparvovec-xxxx).
Zolgensma will require precertification by AmeriHealth New Jersey
effective June 3, 2019.
Newly approved drugs from the FDA
The following drugs were added to the precertification list, as of January 1, 2019, using their clinical (non-brand) name. The precertification list is now updated to reflect the FDA-approved brand names for these drugs:
- Gamifant® (emapalumab-lzsg) – Miscellaneous Therapeutic Agents
- Ultomiris™ (ravulizumab-cwvz) – Miscellaneous Therapeutic Agents
For more information
Medical policies for these drugs are currently in development. In lieu of a published medical policy, requests for these drugs will be subject to precertification review using the FDA-approved guidelines.
These changes are reflected in an updated precertification requirement list, which has been posted to our website.
*This brand name is subject to change, pending final FDA approval.