As of January 1, 2017, new precertification requirements apply to our commercial and Medicare Advantage HMO and PPO members for the following service and drugs eligible for coverage under the medical benefit.

Service

As of January 1, 2017, insulin pumps require precertification approval from Independence.

Drugs

As of January 1, 2017, the drugs listed below require precertification approval from Independence:

• Cinqair^® (reslizumab)
• Cubicin^® (daptomycin)
• Darzalex^TM (daratumumab)
• Erwinaze^® (L-asparaginase)
• Exondys 51^TM (eteplirsen)
• Faslodex^® (fulvestrant)
• Hymovis^® (high molecular weight viscoelastic hyaluronan)
• Inflectra^TM (infliximab)*
• Neulasta^® (pegfilgrastim)*
• Neulasta^® (pegfilgrastim) Onpro^®*
• Sandostatin^® LAR (octreotide acetate)
• Tecentriq^TM (atezolizumab)

In addition, the following drugs are currently pending approval from the U.S. Food and Drug Administration (FDA). Once they receive FDA approval, they will also require precertification approval from Independence:

• Cingal^® (sodium hyaluronate/triamcinolone hexacetonide)
• Ocrevus^TM (ocrelizumab)
• Remune^® (HIV-1 immunogen)

These changes are reflected in an updated precertification requirement list, which is posted to our website.

*Precertification requirements apply to all biosimilars of infliximab and pegfilgrastim approved by the FDA.