As of June 15, 2018, the following specialty drugs, which
are eligible for coverage under the medical benefit, now require
precertification for Independence commercial and Medicare Advantage HMO and PPO
members:
- Crysvita? (burosumab-twza)
- IlumyaTM (tildrakizumab-asmn)
- TrogarzoTM (ibalizumab-uiyk)
Note: Independence's medical policies for these drugs are currently
in development. Until these policies are published, precertification review for
these drugs will be based on the U.S. Food and Drug Administration
(FDA)-approved indication.
In addition, the following drugs are currently pending approval from the
FDA. These drugs will require precertification from Independence once they
receive FDA approval:
- a biosimilar for the drug Soliris? (eculizumab)
- the anti-PD-1 monoclonal antibody cemiplimab
These changes are reflected in an updated precertification requirement list,
which has been posted to our website.