Policies & Regulations
Upcoming changes to the list of specialty drugs that will require precertification

​​Effective July 1, 2024, Independence Blue Cross is making changes to the list of specialty drugs that require precertification under the medical benefit for members enrolled in plans administered by Independence Administrators and our Commercial and Medicare Advantage HMO and PPO plans.

Additions

The following drugs have been approved by the FDA and will require precertification:

  • Avzivi® – Antineoplastic Agents
  • Jubbonti® – Bone-modifying agents
  • Wyost® – Bone-modifying agents
  • Lenmeldy™ – Gene replacement/gene editing therapies
  • Tyenne® – Immunological agents
  • Wezlana™ – Immunological agents
  • Tofidence™ – Immunological agents
  • Udenyca® OnBody – Neutropenia

 

The following drugs are pending FDA approval and will require precertification as of the date they receive FDA approval:

  • patritumab deruxtecan – Antineoplastic Agentsbalstilimab – Anti-PD-1/PD-L1 human monoclonal antibodies
  • obecabtagene autotemcel – Chimeric antigen receptor (CAR-T) therapies
  • marnetegragene autotemcel – Gene replacement/gene editing therapies
  • prademagene zamikeracel – Gene replacement/gene editing therapies
  • eladocagene exuparvovec – Gene replacement/gene editing therapies
  • imetelstat – Miscellaneous therapeutic agents
  • Bmab-100 – Neutropenia
  • afamitresgene autoleucel – Tumor Infiltrating Lymphocyte (TIL) and T-cell Therapies
  • linvoseltamab – Tumor Infiltrating Lymphocyte (TIL) and T-cell Therapies
  • tarlamatab – Tumor Infiltrating Lymphocyte (TIL) and T-cell Therapies

 

Changes

The following drugs were added to the precertification list during a prior update cycle, in advance of their FDA approval. They have since been approved by the FDA, and the precertification list will be updated to reflect the new brand names:

  • debamestrocel will be updated to NurOwn® – Amyotrophic Lateral Sclerosis Agents
  • tislelizumab will be updated to Tevimbra® – Anti-PD-1/PD-L1 human monoclonal antibodies
  • lifileucel will be updated to Amtagvi™ – Tumor Infiltrating Lymphocyte (TIL) and T-cell Therapies
  • apadamtase alfa/inaxadamtase alfa will be updated to Adzynma – Enzyme replacement


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