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Changes to our National Precertification List (NPL)


Important NPL update

As of January 1, 2019, the Centers for Medicare & Medicaid Services (CMS) established new codes for chimeric antigen receptor (CAR) T-cell therapy

  • 0537T
  • 0538T
  • 0539T
  • 0540T

 

Prior to January 1, 2019, CAR T-cell therapy was reported with an unlisted code.

 

The following new-to-market drugs require precertification:

  • Onpattro™ (patisiran) — precertification for both the drug and the site of care is required, effective November 1, 2018.
  • Takhzyro™ (lanadelumab-flyo) — precertification effective November 1, 2018. This drug is included in the hereditary angioedema drug class.
  • Jivi® (antihemophilic factor [recombinant], PEGylated-aucl) — precertification effective November 13, 2018. This drug is included in the blood-clotting-factor drug class.
  • Nivestym™ (filgrastim-aafi) — precertification effective November 20, 2018. This drug is included in the granulocyte colony-stimulating factor (G-CSF) drug class.

 

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

  • Libtayo® (cemiplimab-rwlc)
  • Lumoxiti™ (moxetumomab pasudotox-tdfk)
  •  Panzyga® (immunoglobulin intravenous [human])
  • Tegsedi™ (inotersen)
  • TriVisc™ (sodium hyaluronate)

 

Effective March 1, 2019, the following new-to-market drug requires precertification:

  • Khapzory™ (levoleucovorin)

 

Effective July 1, 2019, we require precertification for both the drug and the site of care for the following drug:

  • Benlysta® (belimumab)

 

You can find more information about precertification under the General Information section of the NPL.