Effective July 5, 2016, ipilimumab (Yervoy^®) will be added to the Dosing and Frequency Program.

Since January 1, 2011, Independence has reviewed the dosing and frequency of administration for select drugs as part of the precertification process. With the addition of Yervoy^® to this program, the drugs that will be reviewed for dosing and frequency are:

• bevacizumab (Avastin^®)*
• cetuximab (Erbitux^®)
• immune globulin, intravenous/subcutaneous (IVIG/SCIG)
• infliximab (Remicade^®)
• ipilimumab (Yervoy^®)
• onabotulinumtoxinA (Botox^®)
• rituximab (Rituxan^®)
• trastuzumab (Herceptin^®)

Independence reserves the right to conduct a post-payment review and audit of claims submitted for any drug that is part of the Dosing and Frequency Program and may recover payments made in excess of the amount approved through the precertification process. For more information on guidelines for the Dosing and Frequency Program, please refer to the specific medical policies for each drug included in the program.

Adjuvant Patient Program for Melanoma

Providers should be aware that Bristol-Myers Squibb, an independent company and the manufacturer of Yervoy^®, offers a patient assistance program called the Adjuvant Patient Program for Melanoma. This program is available for individuals, whether insured or uninsured, who are undergoing adjuvant treatment of fully resected Stage III melanoma (lymph node >1 mm).

Providers should contact Bristol-Myers Squibb to enroll their Independence patients in this program if they are requesting the 10 mg/kg dose for the adjuvant treatment of fully resected Stage III melanoma. Enrollment in this program may yield savings for these individuals. Eligible individuals may receive Yervoy^® free of charge for the duration of treatment, which may be up to three years. Providers who administer Yervoy^® to members enrolled in this program should not submit reimbursement claims for Yervoy^®, as the drug is being supplied at no cost to the provider; however, providers should continue to submit claims for administration of the drug and for any other services rendered during the visit. Eligibility in this program is determined by the drug manufacturer. More information about the program is available from Bristol-Myers Squibb Access Support^® at 1-800-861-0048 or on their website.

Providers can also find additional information about this program in the following Independence medical policies, which will be available on July 5, 2016:

• Commercial: #08.01.01e: Ipilimumab (Yervoy^®)
• Medicare Advantage: #MA08.059b: Ipilimumab (Yervoy^®)

To access medical policies, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, then select Commercial or Medicare Advantage, depending on which version of the policy you?d like to view, and then type the name or policy number in the Search field. To access medical policies from Independence NaviNet^® Plan Central, select Medical Policy Portal under Provider Tools in the right hand column.

Please call 1-800-ASK-BLUE if you have any questions about the precertification process for Yervoy^® or any other drugs included in the Dosing and Frequency Program.

* Only oncology requests for bevacizumab (Avastin^®) require precertification approval for dosing and frequency. Requests for intravitreal injection of bevacizumab (Avastin^®) to treat the ophthalmologic conditions listed in this drug?s medical policy do not require precertification.

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