​​Independence Blue Cross (IBX) and Independence Administrators are updating the specialty medical benefit drugs included in the Most Cost-Effective Setting (MCES) program.  

Members with a current precertification approval to receive these drugs in a hospital outpatient facility may continue treatment until their approval expires. 

Effective July 1, 2026, the following drugs will be reviewed for both setting and medical necessity during the precertification process for members enrolled in Commercial plans:

• Armlupeg® (pegfilgrastim-unne)
• Avlayah™ (tividenofusp alfa-eknm)
• Boncresa® (denosumab-mobz)
• Filkri™ (filgrastim-laha)
• Loargys® (pegzilarginase-nbln)
• Rybrevant Faspro® (amivantamab-hyarluronidase-lpuj)
• Rybrevant® was added under sp​​ecific safety conditions on May 1, 2026, as outlined in IBX is adding certain oncology immunotherapies to its Most Cost-effective Setting program. Rybrevant Faspro will follow the same conditions as outlined under immunotherapy expansion.

At the next precertification review, IBX and Independence Administrators will assess the requested setting alongside medical necessity to determine coverage.

The MCES program helps ensure specialty drugs are administered in safe, cost-effective settings.

Resources  

The updated list, including these changes, will be available before July 1, 2026. To view the current drug list and program details, visit the MCES program webpage.

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