[
Effective January 1, 2018, the following injectable
antiemetic prophylaxis agents for chemotherapy-induced nausea and vomiting
(CINV) will require precertification approval for all Independence members:
- Emend® for injection (fosaprepitant)
- Sustol® (granisetron extended release)
- Cinvanti™ (aprepitant) ? pending FDA approval
- Varubi® (rolapitant) ? pending FDA approval
Requests for members to begin treatment with these drugs on or after January
1, 2018, must be preapproved by Independence, in accordance with the coverage
criteria listed in the Independence medical policies. Members will need to try
one of the other CINV/antiemetic drugs on the formulary (e.g., palonosetron,
granisetron [non-extended release formulation], ondansetron) before they will
be preapproved to receive Emend, Sustol, Cinvanti, or Varubi.
Members who are on an established regimen of Emend, Sustol, Cinvanti, or
Varubi prior to January 1, 2018, will not need to transition
to another CINV/antiemetic drug. However, any new requests submitted for these
drugs for use on or after January 1, 2018, will require precertification review
from Independence.
As a reminder, there is an oral generic version of Emend that may be
available under the member?s pharmacy benefit.
For more information
To learn more, Independence has created the following policies, which will
be posted as Notifications on October 3, 2017, and will become
effective January 1, 2018:
- Commercial: #08.01.41: Fosaprepitant Dimeglumine
(Emend®) and Granisetron (Sustol®)
- Medicare Advantage: #MA08.091: Fosaprepitant Dimeglumine
(Emend®) and Granisetron (Sustol®)
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 Active Notifications.
]