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Two New Components for Precertification

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 components for precertification:

• For all drugs covered under the medical benefit that require precertification, providers will be required to report member demographics, such as height and weight.
• For eight drugs (cetuximab [Erbitux^®]; trastuzumab [Herceptin^®]; onabotulinumtoxinA [Botox^®]; bevacizumab [Avastin^®]; rituximab [Rituxan^®]; oxaliplatin [Eloxatin^®]; intravenous immune globulin [IVIG]; infliximab [Remicade^®]), adherence to Dosing and Frequency Guidelines will be reviewed during precertification.

The Dosing and Frequency Guidelines will be included in the medical policies for these eight drugs. To view the policy notifications for these eight policies, go to www.amerihealth.com/medpolicy, select Accept and Go to Medical Policy Online, and then click on the Policy Notifications box. You can also view policy notifications using the NaviNet^® web portal by selecting Reference Materials and Reports from the Plan Transactions menu and then Medical Policy.

For more information on Dosing and Frequency Guidelines, please refer to the October edition of Partners in Health Update^SM.