Updates to the medical benefit specialty drug cost-share list effective January 1, 2021

October 1, 2020

Effective January 1, 2021, Independence will update 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 will be expanded to include 202 drugs, with the following additions:

  • evinacumab* – Miscellaneous therapeutic agents
  • Fensolvi® – Endocrine/metabolic agents
  • inclisiran* – Miscellaneous therapeutic agents
  • lumasiran* – Miscellaneous therapeutic agents
  • Nyvepria™ – Neutropenia
  • pegunigalsidase alfa* – Enzyme replacement factors
  • sutimlimab* – Miscellaneous therapeutic agents

For drugs that are pending approval from the U.S. Food and Drug Administration (FDA), their official brand names may be different than the names listed above. All names were valid at the time of article publication.

In addition, the following changes will be made to the list:

  • eptacog beta will be changed to Sevenfact®, to reflect its current brand name
  • inebilizumab will be changed to Uplizna™, to reflect its current brand name
  • Lucentis® will now carry a biosimilar indicator, as a biosimilar to Lucentis is in the FDA pipeline; once approved, this biosimilar will also be subject to cost-share
  • Valrox will be changed to Roctavian™, to reflect its current brand name

The above-mentioned changes will be available on our website.

*Pending approval from the FDA.