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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.

     

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