Updates to the list of specialty drugs that will require precertification as of September 1, 2020

July 31, 2020

The following specialty drugs, which have been approved by the U.S. Food and Drug Administration (FDA) and are eligible for coverage under the medical benefit for Independence commercial and Medicare Advantage HMO and PPO members, will require precertification as of September 1, 2020:

  • Darzalex Faspro™ (daratumumab and hyaluronidase human-fihj)
  • Nyvepria™ (pegfilgrastim-apgf)
  • Phesgo™ (pertuzumab/trastuzumab/hyaluronidase-zzxf)

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Independence is developing medical policies for these drugs. In the absence of a published medical policy, coverage requests for these drugs will be subject to review in accordance with the FDA-approved indications and Independence-recognized compendia.

These changes will be reflected in an updated precertification requirement list, which will be posted to our website.