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Effective January 1, 2018, the following injectable
antiemetic prophylaxis agents for chemotherapy-induced nausea and vomiting
(CINV) will require precertification approval for all AmeriHealth members:
- Emend® for injection (fosaprepitant)
- Sustol® (granisetron extended release)
- Cinvanti™ (aprepitant) ? pending FDA approval
- Varubi® (rolapitant) ? pending FDA approval
Requests for members to begin treatment with these drugs on or after January
1, 2018, must be preapproved by AmeriHealth, in accordance with the coverage
criteria listed in the AmeriHealth medical policy. Members will need to try one
of the other CINV/antiemetic drugs on the formulary (e.g., palonosetron,
granisetron [non-extended release formulation], ondansetron) before they will
be preapproved to receive Emend, Sustol, Cinvanti, or Varubi.
Members who are on an established regimen of Emend, Sustol, Cinvanti, or
Varubi prior to January 1, 2018, will not need to transition
to another CINV/antiemetic drug. However, any new requests submitted for these
drugs for use on or after January 1, 2018, will require precertification review
from AmeriHealth.
As a reminder, there is an oral generic version of Emend that may be
available under the member?s pharmacy benefit.
For more information
To learn more, AmeriHealth has created Medical Policy #08.01.41:
Fosaprepitant Dimeglumine (Emend®) and Granisetron
(Sustol®), which will be posted as a Notification on
October 3, 2017, and will become effective January 1, 2018.
To view the Notification for this policy, visit our Medical Policy Portal. Select Accept and Go to Medical
Policy Online, and then select Commercial under Active
Notifications.
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