|Effective January 1, 2023, from Independence Blue Cross: (Independence) IBC will add 12 drugs to the list of specialty drugs that require precertification under the medical benefit. With these additions, Independence now requires precertification for a total of 271 drugs before members can receive coverage for them. The drugs being added include several gene replacement therapies and cancer/antineoplastic agents in the U.S. Food and Drug Administration (FDA) pipeline, as well as several biosimilars that recently received FDA approval. |
The newly added drugs are:
beremagene geperpavec* – gene replacement/gene editing therapies
CimerliTM (ranibizumab‑eqrn) – ophthalmic agents
ElahereTM (mirvetuximab soravtansine) – antineoplastic agents
Fylnetra® (pegfilgrastim‑pbbk)† – neutropenia
Hemgenix® (etranacogene dezaparvovec) – gene replacement/gene editing therapies
mosunetuzumab* – antineoplastic agents
Skysona® (elivaldogene autotemcel) – gene replacement/gene editing therapies
Stimufend® (pegfilgrastim‑fpgk)† – neutropeniatofersen* – amyotrophic lateral sclerosis agents
tremelimumab* – antineoplastic agents
Vegzelma® (bevacizumab‑adcd)† – antineoplastic agents
Zynteglo® (betibeglogene autotemcel) – gene replacement/gene editing therapies
We often add drugs to the precertification list before they receive FDA approval.
This allows us to manage potentially high‑impact drugs as soon as they enter the market. Our comprehensive medical policies identify the coverage criteria that members must meet to receive precertification approval. In the absence of a published medical policy, precertification requests are subject to review in accordance with FDA labeling and published, peer‑reviewed literature.
Questions about your plan’s drug formulary? Contact your Total Benefit Solutions, Inc health insurance specialist at (215)355-2121 or www.totalbenefits.net