Effective July 1, 2022, AmeriHealth Pennsylvania will update its list of specialty drugs that require member cost-sharing (i.e., 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 2022 cost-share list includes 213 drugs, with the following additions:
- Apretude (cabotegravir) – Human immunodeficiency virus agents
- Byooviz (ranibizumab-nuna) – Ophthalmic agents
- Elivaldogene autotemcel* – Gene replacement therapy
- Infliximab (unbranded) – Immunological agents
- Lenacapavir* – Human immunodeficiency virus agents
- Releuko™ (filgrastim-ayow) – Neutropenia
- Skyrizi® (IV)* (risankizumab-rza) – Immunological agents
- Spesolimab* – Immunological agents
- Tezspire™ (tezepelumab) – Respiratory agents
In addition, the following changes to the list are effective July 1, 2022:
- Bebulin (factor IX complex, human) was removed from the list, as this drug is no longer available
- Carimune® NF (immune globulin intravenous, human) was removed from the list, as this drug is no longer available
- Faricimab was changed to Vabysmo®, to reflect its FDA-approved brand name
- Inclisiran was changed to Leqvio®, to reflect its FDA-approved brand name
- Lucentis® PDS (ranibizumab injection) was changed to Susvimo™, to reflect its FDA-approved brand name
- Sutimlimab was changed to Enjaymo™, to reflect its FDA-approved brand name
- Tanezumab was removed from the list, as this drug is no longer available
An updated medical benefit specialty drug cost-share list will be available on our website prior to July 1, 2022.
*Pending approval from the U.S. Food and Drug Administration (FDA). After these drugs receive FDA approval, their brand names may change from those listed above. All names were valid at the time of article publication.