As a reminder, in 2016 new precertification requirements will apply to our commercial and Medicare Advantage HMO and PPO members for the following service and drugs.

Service

Bronchial thermoplasty will require precertification approval from Independence in 2016 as follows:

• Effective January 1, 2016, precertification will be required for members enrolled in Medicare Advantage plans.
• Effective March 1, 2016, precertification will be required for members enrolled in commercial plans.

Drugs

As of January 1, 2016, the seven medical benefit drugs listed below will require precertification approval from Independence:

• Adagen^® (pegademase bovine)
• Blincyto^® (blinatumomab)
• Cyramza^® (ramucirumab)
• Imlygic^™ (talimogene laherparepvec)
• Kanuma^™ (sebelipase alfa)*
• Lemtrada^® (alemtuzumab)
• Nucala^® (mepolizumab)

These changes will be reflected in updated precertification requirement lists, which will be posted later this month on our website.

In addition, Notifications for the medical policies for Adagen (pegademase bovine) and Cyramza (ramucirumab) will be available this month:

• Adagen (pegademase bovine):
• Commercial: #08.01.26: Pegademase bovine (Adagen^®)
• Cyramza (ramucirumab):
• Commercial: #08.01.25: Ramucirumab (Cyramza^®)
• Medicare Advantage: #MA08.075: Ramucirumab (Cyramza^®)

To view the Notifications for these policies, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select Commercial or Medicare Advantage under Notifications.

In January 2016, new policies for Imlygic^™ (talimogene laherparepvec) and Nucala^® (mepolizumab) will be made available. Medical necessity criteria for these drugs will be based on the U.S. Food and Drug Administration (FDA)-approved indications.

*Pending approval from the FDA