As a reminder, effective January 1, 2019, AmeriHealth Pennsylvania will update its list of specialty drugs that require member cost-sharing (e.g., 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*
• Fulphila^TM (pegfilgrastim-jmdb)^?
• Ilaris^? (canakinumab)
• Jivi^? (recombinant PEGylated-aucl)
• Onpattro^TM (patisiran)
• ravulizumab*
• Triptodur^? (triptorelin)

In addition, all specialty drugs that are classified by AmeriHealth as Gene Therapy (e.g., Luxturna^TM [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.