As of January 1, 2020, AmeriHealth Pennsylvania
updated 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 cost-share list was expanded to include 186 drugs, including the
following additions:
- abicipar*
- Adakveo® (crizanlizumab-tmca)
- Beovu® (brolucizumab-dbll)
- cabotegravir*
- cosyntropin depot*
- eptacog-beta*
- eptinezumab*
- Lapelga (pegfilgrastim)*
- leuprolide mesylate*
- Reblozyl® (luspatercept-aamt)
- Rethymic™ (RVT-802) – CHANGED
to FDA-approved brand name
- Synojoynt™ (1% sodium hyaluronate solution)
- Triluron™ (sodium hyaluronate)
- Xembify® (immune globulin subcutaneous, human-klhw)
- Zynteglo™ (betibeglogene darolentivec)*
The updated list of specialty drugs with cost-sharing is available on our website.
*Pending approval from the U.S. Food and Drug
Administration (FDA).