​​​​​Beginning January 1, 2027, Independence Blue Cross (IBX) and Independence Administrators will update the list of specialty drugs that require precertification under the medical benefit for members enrolled in plans administered by Independence Administrators and IBX Commercial and Medicare Advantage HMO and PPO plans. 

These updates include newly approved therapies, several existing products that will newly require precertification, and select products that will become preferred and no longer require precertification.

What providers need to know

To help avoid delays in treatment and claims processing, providers are encouraged to review these changes before January 1, 2027. Please submit precertification requests before administering any drug that requires prior approval under the medical benefit.

For the most current specialty drug precertification requirements, visit the Medical Policy Portal and search Drug Pharmacologic or Biologic Medical Necessity Review.

New specialty drugs requiring precertification

The following U.S. Food and Drug Administration (FDA)-approved specialty drugs will require precertification beginning January 1, 2027:

• Revtorpyk™ (gedatosilib) – Antineoplastic Agents
• Sarclisa Escena™ (isatuximab-irfc) – Antineoplastic Agents
• Tudriqev™ (vusolimgene oderparepvec-wtpg) – Antineoplastic Agents
• Zimrixby™ (rituximab-cdxx) – Antineoplastic Agents
• Ponlimsi™ (densoumab-adet) – Bone-modifying Agents
• Fayuvi™ (rebisufligene etisparvovec-hopf) – Gene Replacement / Gene Editing Therapies
• Genglycos™ (pariglasgene brecaparvovec-opnr) – Gene Replacement / Gene Editing Therapies
• Bexlutry™ (lutetium Lu 177 dotatate) – Miscellaneous Therapeutic Agents
• Isembyld™ (apitegromab-mstn) – Miscellaneous Therapeutic Agents
• Omisirge® (omidubicel-onlv) – Miscellaneous Therapeutic Agents
• Pasatru™ (garetosmab-grts) – Miscellaneous Therapeutic Agents
• Ryoncil® (remestemcel-L-rknd​) – Miscellaneous Therapeutic Agents
• Yartemlea™ (narsoplimab-wuug) – Miscellaneous Therapeutic Agents
• Zanvastro™ (zilganersen) – Miscellaneous Therapeutic Agents
• Lumvoa™ (veligrotug-vvze) – Ophthalmic Agents
• Lytenava™ (bevacizumab-vikg) – Ophthalmic Agents
• Ranluspec™ (ranibizumab-hkdz) – Ophthalmic Agents
• Tregzi™ (Orca-T) – Tumor Infiltrating Lymphocyte and other T-Cell Therapies

Existing drugs newly requiring precertification

The following drugs are currently available without precertification, but will require precertification beginning January 1, 2027:

• Jubbonti® / Wyost® (denosumab-bbdz) – Bone-modifying Agents
• Kanjinti® (trastuzumab-anns) – Neutropenia

Drugs pending FDA approval

The following drugs are pending FDA approval and will require precertification upon date of FDA approval: 

• Ivonescimab – Anti-PD-1
• Serplulimab – Anti-PD-1
• Ifinatamab deruxtecan – Antineoplastic agents
• Anitocabtagene autoleucel – CAR-T Therapies
• Lonvoguran ziclumeran (lonvo-z) – Gene Replacement / Gene Editing Therapies
• Imsidolimab – Immunological Agents
• Doruxapapogene ralaplasmid – Miscellaneous Therapeutic Agents
• Adrabetadex – Miscellaneous Therapeutic Agents
• Lorecivivint – Miscellaneous Therapeutic Agents

Products no longer requiring precertification

The following drugs will become preferred products effective January 1, 2027, and will no longer require precertification:

• Trazimera® (trastuzumab-qyyp) – Antineoplastic Agents
• Bildyos™ and Bilprevda™ (denosumab-nxxp) – Bone-modifying Agents
• Enoby™ and Xtrenbo™ (denosumab-qbde) – Bone-modifying Agents
• Vegzelma® (bevacizumab-adcd) – Ophthalmic Agents