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Specialty drugs that require precertification as of July 1, 2019

July 1, 2019

As a reminder, as of July 1, 2019, the following specialty drugs, which are eligible for coverage under the medical benefit for Independence commercial and Medicare Advantage HMO and PPO members, require precertification:

  • Asceniv™ (immune globulin intravenous, human-slra, 10% liquid) – Intravenous/Subcutaneous Immune Globulin (IVIG/SCIG)
  • Evenity™ (romosozumab-aqqg) – Bone-Modifying Agents
  • Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk) – Antineoplastic Agents
  • Trazimera™ (trastuzumab-qyyp) – Antineoplastic Agents

In addition, the gene therapy drug Zolgensma® (onasemnogene abeparvovec-xioi) was updated to reflect its approval by the U.S. Food and Drug Administration (FDA) on May 24, 2019.

Updated policies

The following policies have been updated to include Asceniv:

  • Commercial: 08.00.13u: Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
  • Medicare Advantage: MA08.009g: Immune Globulin: Intravenous (IVIG), Subcutaneous (SCIG)

Medical policies for all other drugs are currently in development. In lieu of published policies, requests for these drugs will be subject to FDA-approved indications and guidelines. To access medical policies, visit our Medical Policy Portal.

These changes are reflected in an updated precertification requirement list, posted on our website.

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