Effective January 1, 2020, the following specialty drugs, which are eligible for coverage under the medical benefit for Independence commercial and Medicare Advantage HMO and PPO members, will require precertification:

• Eylea^® (aflibercept) – Ophthalmic agents
• Kanjinti^TM (trastuzumab-anns) – Cancer
• Lucentis^® (ranibizumab) – Ophthalmic agents
• Macugen (pegaptanib) – Ophthalmic agents
• Polivy^TM (polatuzumab vedotin-piiq) – Cancer
• Revatio^® (sildenafil) – Pulmonary arterial hypertension
• Ruxience^TM (rituximab-pvvr) – Cancer
• Synojoynt^TM (sodium hyaluronate) – Hyaluronate acid products
• Triluron^TM (sodium hyaluronate) – Hyaluronate acid products
• Tyvaso^® (treprostinil) – Pulmonary arterial hypertension
• Ventavis^® (iloprost) – Pulmonary arterial hypertension
• Zirabev (bevacizumab-bvzr) – Cancer

In addition, the following drugs are currently pending approval from the U.S. Food and Drug Administration (FDA) and will require precertification for Independence members once they receive FDA approval in 2020, or as of January 1, 2020, for any drug approved in 2019:

• abicipar – Ophthalmic agents
• brolucizumab – Ophthalmic agents
• casimersen – Duchenne muscular dystrophy
• cosyntropin depot – Endocrine/metabolic agents
• crizanlizumab – Miscellaneous therapeutic agents
• eptinezumab – Miscellaneous therapeutic agents
• givosiran – Miscellaneous therapeutic agents
• golodirsen – Duchenne muscular dystrophy
• isatuximab – Cancer
• Lapelga (pegfilgrastim) – Colony-stimulating factor
• lisocabtagene maraleucel – Chimeric antigen receptor therapy
• margetuximab – Cancer
• Reblozyl (luspatercept-ammt) – Miscellaneous therapeutic agents
• RVT-802 – Miscellaneous therapeutic agents
• viltolarsen – Duchenne muscular dystrophy
• Zynteglo (betibeglogene darolentivec) – Gene Therapy

Lastly, the following drugs will no longer require precertification approval from Independence as of January 1, 2020:

• Beleodaq^® (belinostat) – Cancer
• Folotyn^TM (pralatrexate) – Cancer
• Imlygic^® (talimogene laherparepvec) – Cancer
• Istodax^® (romidepsin) – Cancer
• Monovisc^® (high molecular weight hyaluronan) – Hyaluronate acid products

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In the absence of a published medical policy on any of these newly approved drugs, all requests will be subject to review in accordance with the FDA-approved indications and Independence-recognized compendia.

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