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Reminder: Changes to precertification requirements for 2016

December 30, 2015

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 medical benefit drugs listed below will require precertification approval from Independence:

  • Adagen® (pegademase bovine)
  • Blincyto® (blinatumomab)
  • Cyramza® (ramucirumab)
  • Gel-Syn™ (sodium hyaluronate)
  • GenVisc 850® (sodium hyaluronate)
  • Imlygic™ (talimogene laherparepvec)
  • Kanuma™ (sebelipase alfa)
  • Lemtrada® (alemtuzumab)
  • Nucala® (mepolizumab)
  • VISCO-3™ (sodium hyalrunate)
  • Zevalin® (ibritumomab tiuxetan)*

These changes are reflected in an updated precertification requirement list.

*Precertification review for this drug is currently provided by CareCore National, LLC d/b/a eviCore healthcare (eviCore), an independent company.

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