Updates to the medical benefit specialty drug cost-share list effective January 1, 2022

October 21, 2021

Effective January 1, 2022, Independence will update its list of specialty drugs that require member cost-sharing (i.e., 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 2022 cost-share list includes 207 drugs, with the following additions:

  • donislecel* – Miscellaneous therapeutic agents
  • efbemalenograstim* – Neutropenia
  • faricimab* – Ophthalmic agents
  • Lucentis® Port Delivery System (PDS)* – Ophthalmic agents
  • plinabulin* – Neutropenia
  • tanezumab* – Miscellaneous therapeutic agents
  • vutrisiran* – Miscellaneous therapeutic agents

After these drugs receive approval from the U.S. Food and Drug Administration (FDA) their brand names may change from those listed above. All names were valid at the time of article publication.

In addition, the following changes to the list are effective January 1, 2022:

  • anifrolumab was changed to Saphnelo™, to reflect its FDA-approved brand name
  • avalglucosidase alfa was changed to Nexviazyme™, to reflect its FDA-approved brand name
  • Fasenra® was removed from the list, as this drug is now only eligible for coverage under the Pharmacy benefit
  • leuprolide mesylate was changed to Camcevi™, to reflect its FDA-approved brand name
  • Lutrate® was removed from the list, as this drug is no longer on the market
  • Nucala® was removed from the list, as this drug is now only eligible for coverage under the Pharmacy benefit
  • Ryplazim® was removed from the list

The medical benefit specialty drug cost-share lists are available on our website.

*Pending approval from the FDA.