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Changes to our National Precertification List (NPL)

 

Effective July 1, 2020, the following precertification changes apply:
 

  • We’ll require precertification for the following:
    • Functional endoscopic sinus surgery (FESS)
    • Revision of shoulder arthroplasty
    • Arthrodesis for spine deformity
    • Kyphectomy
  • We’ll require precertification for the following drugs:
    • Avastin® (bevacizumab)
    • BelrapzoTM (bendamustine HCl)
    • Bendeka® (bendamustine HCl)
    • Feraheme ® (ferumoxytol)
    • Injectafer® (ferric carboxymaltose injection)
    • MvasiTM (bevacizumab-awwb)
    • Sandostatin® (octreotide)
    • Somatuline® (lanreotide)
    • Treanda® (bendamustine hydrochloride)
    • ZirabevTM (bevacizumab-bvzr)
    • Zoladex® (goserelin)
    • ZulressoTM (brexanolone)
  • We’ll require precertification for the drug and site of care for the following drugs:
    • Bavencio® (avelumab)
    • Imfinzi® (durvalumab)
    • Keytruda® (pembrolizumab)
    • Libtayo® (cemiplimab-rwlc)  
    • Opdivo® (nivolumab)
    • Tecentriq® (atezolizumab)
    • Yervoy® (ipilimumab)

The following new-to-market drugs require precertification:

  • RinvoqTM (upadacitinib) — precertification required, effective November 1, 2019. This drug is included in the immunologic agent class.
  • SynojoyntTM (1% sodium hyaluronate) — precertification required, effective November 5, 2019. This drug is included in the viscosupplement class.
  • TriluronTM (1% sodium hyaluronate) — precertification required, effective November 5, 2019. This drug is included in the viscosupplement class.
  • Beovu® (brolucizumab-dbll) — precertification required, effective January 1, 2020. This drug is included in the ophthalmic medical injectable class.
  • Xembify® (immune globulin-klhw) — precertification for both the drug and the site of care required, effective January 1, 2020.
  • GivlaariTM (givosiran) — precertification for both the drug and site of care required, effective February 1, 2020.

 

We encourage you to submit precertification requests at least two weeks before the scheduled services. 

To save time, request precertification electronically — it’s fast and simple. Most precertification requests can be submitted electronically through the provider website or by using your Electronic Medical Record (EMR) system portal.  You can find more information about precertification under the General Information section of the NPL.