July 2021
The following formulary changes are for Neighborhood Medicaid:
- Advate [Antihemophilic Factor (Recombinant)]
- BeneFix [Coagulation Factor IX (Recombinant)]
Beginning June 1, 2021, Neighborhood will exclusively cover Advate and BeneFix for Medicaid members through the Pharmacy Benefit.
- To obtain paid claims for Advate and BeneFix products for Neighborhood Medicaid members on or after June 1st, 2021, please submit claims under the Pharmacy Benefit.
Utilization management protocols for Medicaid, Commercial and INTEGRITY remain unchanged and authorization must be requested prior to dispensing Advate and BeneFix. For Medicaid members with active Advate and BeneFix authorizations, their authorization will carry over to the pharmacy benefit for the remainder of the authorization duration.
The following formulary changes are for Neighborhood Commercial/Exchange lines of business:
- Hemlibra (emicizumab-kxwh)
Beginning June 1, 2021, Neighborhood will exclusively cover Hemlibra for Commercial members through the Pharmacy Benefit.
- To obtain paid claims for Hemlibra products for Neighborhood Commercial members on or after June 1st, 2021, please submit claims under the Pharmacy Benefit.
Utilization management protocols for Medicaid, Commercial and INTEGRITY remain unchanged and authorization must be requested prior to dispensing Hemlibra. For Commercial members with active Hemlibra authorizations, their authorization will carry over to the pharmacy benefit for the remainder of the authorization duration.