Independence Blue Cross (IBX) and Independence Administrators have made changes to the specialty medical benefit drugs in the Most Cost-Effective Setting Program.
As of July 1, 2024, the following drugs will be reviewed for setting, as well as medical necessity, as part of the precertification process for members enrolled in Commercial plans:
- Adzynma (ADAMTS13, recombinant-krhn)
- Briumvi® (ublituximab-xiiy)
- Jubbonti® (denosumab-bbdz)
- Selarsdi™ (ustekinumab-aekn)
- Tyenne® (tocilizumab-aazg)
- Udenyca Onbody™ (pegfilgrastim-cbqv)
- Veopoz™ (pozelimab-bbfg)
Based upon clinical review, IBX and Independence Administrators have elected to remove the following products from the Most Cost-Effective Setting Program:
- Phesgo® (pertuzumab-trastuzumab-hy-zzxf)
- Xenpozyme® (olipudase alfa-rpcp)
Members who have a current precertification approval to receive these drugs in a hospital outpatient facility may continue treatment in this setting until their precertification approval expires. At the next precertification review, IBX and Independence Administrators will evaluate the requested setting and make a coverage determination.
With our Most Cost-Effective Setting Program, IBX and Independence Administrators seek to ensure that members receive treatment with specialty medical benefit drugs in settings that are safe and cost-effective.
Resources
For more information, including a list of all 90 drugs in the program, visit our Most Cost-Effective Setting Program webpages: