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Changes to our National Precertification List (NPL)


Important NPL updates
 

The following new-to-market drugs require precertification:
 

  • UltomirisTM (ravulizumab-cwvz) – precertification for both the drug and the site of care effective March 15, 2019.
  • Mavenclad® (cladribine) – precertification effective May 15, 2019. This drug is included in the multiple sclerosis drug class.
  • Mayzent® (siponimod) – precertification effective May 15, 2019. This drug is included in the multiple sclerosis drug class.
  • SpravatoTM (esketamine) – precertification effective May 15, 2019.
  • Zolgensma® (onasemnogene abeparvovec-xioi) - precertification for both the drug and the site of care effective July 1, 2019.

Effective July 1, 2019, the following new-to-market drugs require precertification:
 

  • Evenity® (romosozumab-aqqg)
  • SkyriziTM (risankizumab-rzaa)
  • Herceptin HylectaTM (trastuzumab and hyaluronidase-oysk)


Effective August 1, 2019, precertification is required for both the drug and site of care for Cutaquig® (IVIG).
 

Effective January 1, 2020, precertification is required for both the drug and the site of care for the following drugs:
 

  • Cinryze® (C1 esterase inhibitor)
  • Aralast® NP (alpha 1-proteinase inhibitor)
  • GlassiaTM (alpha 1-proteinase inhibitor)
  • Prolastin®-C (alpha 1-proteinase inhibitor)
  • Zemaira® (alpha 1-proteinase inhibitor)
  • Aldurazyme® (laronidase)
  • Cerezyme® (imiglucerase)
  • Elaprase® (idursulfase)
  • Elelyso® (taliglucerase alfa)
  • Fabrazyme® (agalsidase beta)
  • Kanuma® (sebelipase alfa)
  • Lumizyme® (alglucosidase alfa)
  • MepseviiTM (vestronidase alfa-vjbk)
  • Naglazyme® (galsulfase)
  • Vimizim® (elosulfase alfa)
  • VPRIV® (velaglucerase alfa)


Effective January 1, 2020, the following drugs will no longer require precertification:
 

  • Krystexxa® (pegloticase)
  • Gazyva® (obinutuzumab) 


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.