New Requirements for Precertification and User Guide Available
AmeriHealth requires that certain drugs receive precertification before coverage is available for our members. Precertification ensures that members meet the medical necessity criteria listed in our policies. Effective January 1, 2011, there will be two new requirements for precertification:
- For all drugs covered under the medical benefit that require precertification, providers must report additional member data, such as height and weight.
- For the following eight drugs, Dosing and Frequency Requirements will be applied during precertification:
- bevacizumab (Avastin®)
- cetuximab (Erbitux®)
- infliximab (Remicade®)
- intravenous immune globulin (IVIG)
- onabotulinumtoxinA (Botox®)
- oxaliplatin (Eloxatin®)
- rituximab (Rituxan®)
- trastuzumab (Herceptin®)
Read the complete article in the December edition of Partners in Health UpdateSM.
