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Changes to our National Precertification List (NPL)


Important NPL update
 

Effective January 1, 2021, the following precertification changes will apply:
 

  • We require precertification for hip surgery to treat impingement syndrome, and effective January 1, 2021, we are expanding to include labral repair.

The following new-to-market drugs require precertification:
 

  • TepezzaTM (teprotumumab-trbw) — precertification required, effective May 1, 2020. This drug is included in the ophthalmic medical injectables category.
  • Sarclisa® (isatuximab-irfc) — precertification required, effective May 28, 2020.
  • Vyepti TM (eptinezumab-jjmr) — precertification for both the drug and site of care required, effective May 28, 2020. This drug is included in the calcitonin gene-related peptide receptor inhibitors category.

Effective July 9, 2020, the following new-to-market drugs require precertification:
 

  • Sevenfact® (coagulation factor VIIa [recombinant]-jncw)
  • Trodelvy TM (sacituzumab govitecan-hziy)
  • Zeposia® (ozanimod)

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

To save time, request precertification electronically — it’s fast, secure and simple. You can submit most precertification requests 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.