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Reminder: Upcoming changes to precertification requirements for medical benefit drugs

December 1, 2014

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As previously communicated, effective January 1, 2015, new precertification requirements will apply to our commercial and Medicare Advantage HMO and PPO members for the medical benefit drugs listed below.

The following medical benefit drugs will be added to the precertification requirement list effective January 1, 2015:

  • BeleodaqTM (belinostat)
  • EntyvioTM (vedolizumab)
  • Keytruda® (pembrolizumab)
  • nivolumab (anti-PD-1 human monoclonal antibodies)*
  • Ruconest® (recombinant C1-esterase inhibitor)
  • SylvantTM (siltuximab)

In addition, the following medical benefit drugs will no longer require precertification approval effective January 1, 2015:

  • Aredia® (pamidronate disodium)
  • Arzerra® (ofatumumab)
  • Boniva® injection (ibandronate sodium)
  • Ceredase® (alglucerase)
  • Eloxatin® (oxaliplatin)
  • Nulojix® (belatacept)
  • Orthovisc® (high molecular weight hyaluronan)
  • Synvisc® (hylan G-F 20)
  • Synvisc-One® (hylan G-F 20)

These changes will be reflected in an updated precertification requirement list, which will be available later this month at the Preapproval/Precertification Requirements and Member Cost-Sharing page of our website.

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

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