Effective January 1, 2017, new precertification requirements will 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 will require precertification approval from Independence.

Drugs

As of January 1, 2017, the drugs listed below will 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 will be reflected in an updated precertification requirement list, which will be posted to our website later this month, prior to these changes going into effect.

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