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Updates to the medical benefit specialty drug cost-sharing list for 2020

January 2, 2020

As of January 1, 2020, Independence updated its list of specialty drugs that require member cost-sharing (e.g., copayment, deductible, and coinsurance). Cost-sharing applies to select medical benefit specialty drugs for members who are enrolled in Commercial FLEX products and other select plans. The member’s cost-sharing amount is based on the terms of the member’s benefit contract. In accordance with your Provider Agreement, it is the provider’s responsibility to verify a member’s individual benefits and cost-share requirements.

The cost-share list was expanded to include 186 drugs, including the following additions:

  • abicipar*
  • Adakveo® (crizanlizumab-tmca)
  • Beovu® (brolucizumab-dbll)
  • cabotegravir*
  • cosyntropin depot*
  • eptacog-beta*
  • eptinezumab*
  • Lapelga (pegfilgrastim)*
  • leuprolide mesylate*
  • Reblozyl® (luspatercept-aamt)
  • Rethymic™ (RVT-802) – CHANGED to FDA-approved brand name
  • Synojoynt™ (1% sodium hyaluronate solution)
  • Triluron™ (sodium hyaluronate)
  • Xembify® (immune globulin subcutaneous, human-klhw)
  • Zynteglo™ (betibeglogene darolentivec)*

The updated list of specialty drugs with cost-sharing is available on our website.

*Pending approval from the U.S. Food and Drug Administration (FDA).


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