Effective June 3, 2019, the AmeriHealth Dosage and Frequency Program will be expanded to include 16 additional drugs that are eligible for coverage under the medical benefit. Most of these drugs are enzyme replacement drugs and biosimilars to originator products that are already part of this program.  

The following is the comprehensive list of drugs that will be reviewed for dosage and frequency:  

• Adagen^® (pegademase bovine) – New for June 3, 2019
• Aldurazyme^® (laronidase) – New for June 3, 2019
• Avastin^® (bevacizumab)*^†
• Bivigam^® (immune globulin intravenous [human])
• Blincyto^® (blinatumomab)
• Brineura^™ (cerliponase alfa) – New for June 3, 2019
• Carimune^® NF (immune globulin intravenous [human])
• Cerezyme^® (imiglucerase) – New for June 3, 2019
• Cutaquig^® (immune globulin subcutaneous [human]) 
• Cuvitru^™ (immune globulin subcutaneous [human])
• Elaprase^® (idursulfase) – New for June 3, 2019
• Elelyso^® (taliglucerase alfa) – New for June 3, 2019
• Entyvio^® (vedolizumab)
• Erbitux^® (cetuximab)
• Fabrazyme^® (agalsidase beta) – New for June 3, 2019
• Flebogamma^® (immune globulin intravenous [human])
• Flebogamma^® DIF (immune globulin intravenous [human])
• Gamastan^® S/D (immune globulin [human])
• Gamifant^® (emapalumab-lzsg) 
• Gammagard^® Liquid (immune globulin infusion [human])
• Gammagard^® S/D (immune globulin intravenous [human])
• Gammaked^™ (immune globulin [human])
• Gammaplex^® (immune globulin intravenous [human])
• Gamunex^®-C (immune globulin injection [human])
• Herceptin^® (trastuzumab)^†
• Herzuma^® (trastuzumab-pkrb) – New for June 3, 2019
• Hizentra^® (immune globulin subcutaneous [human])
• HyQvia^® (immune globulin infusion [human])
• Ilaris^® (canakinumab) 
• Inflectra^® (infliximab-dyyb)
• Ixifi^™ (infliximab-qbtx)
• Kanuma^® (sebelipase alfa)
• Lumizyme^™ (alglucosidase alfa) – New for June 3, 2019
• Mepsevii^™ (vestronidase alfa-vjbk) –New for June 3, 2019
• Mvasi^™ (bevacizumab-awwb)*
• Naglazyme^® (galsulfase) – New for June 3, 2019
• Octagam^® (immune globulin intravenous [human])
• Ogivri^™(trastuzumab-dkst)
• Onpattro^™ (patisiran)
• Ontruzant^® (trastuzumab-dttb) – New for June 3, 2019
• Panzyga^® (immunoglobulin intravenous)
• Privigen^® (immune globulin intravenous)
• Remicade^® (infliximab)^†
• Renflexis^® (infliximab-abda)
• Revcovi^™ (elapegademase-lvlr) – New for June 3, 2019
• Rituxan^® (rituximab)^†
• Rituxan Hycela^™ (rituximab/hyaluronidase human for subcutaneous injection)
• Sandostatin^® LAR Depot (octreotide acetate)
• Spinraza^® (nusinersen)
• Stelara^® (ustekinumab)
• Truxima^® (rituximab-abbs) – New for June 3, 2019
• Ultomiris^™ (ravulizumab-cwvz) 
• Vimizim^® (elosulfase alfa) – New for June 3, 2019
• VPRIV^® (velaglucerase alfa) – New for June 3, 2019
• Xolair^® (omalizumab)
• Yervoy^® (ipilimumab)

About the Dosage and Frequency Program

Since January 1, 2011, AmeriHealth has reviewed the requested dosage and frequency of administration for select drugs as part of the precertification process. Coverage of the drugs included in this program is contingent upon review by AmeriHealth for appropriate dosage and frequency. Providers who request coverage above the dosage and frequency requirements listed in the medical policies for each drug will be required to submit documentation (i.e., published peer-reviewed literature) to AmeriHealth to support the request. Members who are currently receiving any drug on this program are subject to Dosage and Frequency review at every renewal of precertification.

AmeriHealth reserves the right to conduct a post-payment review and audit of claims submitted for any drug that is part of the Dosage and Frequency Program and may recover payments that exceed the amount approved through the precertification process. For more information on the dosage and frequency guidelines, please refer to the specific policies for each drug included in the program.

If you have any questions about the precertification process for drugs included in the Dosage and Frequency Program, please call the AmeriHealth Clinical Services department at 1-888-YOUR-AH1 for AmeriHealth New Jersey and 1-800-275-2583 for AmeriHealth Pennsylvania.

Updated policies

Medical policies for the newly added drugs are currently in development. In lieu of published policies, AmeriHealth will follow the dosage and frequency guidelines listed in the prescribing information for each drug, as approved by the U.S. Food and Drug Administration (FDA).

To access medical policies, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online and then type the policy name or number in the Search field.

*Bevacizumab (Avastin^®, Mvasi^™) only requires precertification approval for dosage and frequency for oncologic indications. Coverage requests for intravitreal injection of bevacizumab (Avastin^®, Mvasi^™) to treat the ophthalmologic conditions listed in this drug’s policies do not require precertification.

^†Dosage and frequency requirements apply to all FDA-approved biosimilars to this originator product.