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Upcoming changes to drug precertification requirements for 2016

October 1, 2015

Effective January 1, 2016, new precertification requirements will apply to our commercial HMO and PPO and Medicare Advantage HMO members for the eight medical benefit drugs listed below:
  • Adagen® (pegademase bovine)
  • Blincyto® (blinatumomab)
  • Cyramza® (ramucirumab)
  • KanumaTM (sebelipase alfa)*
  • Lemtrada® (alemtuzumab)
  • mepolizumab*
  • talimogene laherparepvec*
  • Zevalin® (ibritumomab tiuxetan)
These changes will be reflected in updated precertification requirement lists, which will be posted on the AmeriHealth Pennsylvania website in December, prior to these changes going into effect. Look for more information about the availability of the new precertification requirement lists in the December 2015 edition of Partners in Health UpdateSM.

*Pending approval from the U.S. Food and Drug Administration

Precertification review for this drug is currently provided by CareCore National, LLC d/b/a eviCore healthcare (eviCore) for AmeriHealth Pennsylvania HMO members. Precertification for this drug will be reviewed by eviCore starting January 1, 2016, for all AmeriHealth New Jersey members.


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