Changes to our National Precertification List (NPL)
This update applies to both our commercial and Medicare members.

New-to-market drugs that require precertification
• Elfabrio® (pegunigalsidase alfa-iwxj) — precertification is required for the drug and site of care effective August 1, 2023. This drug is part of the enzyme replacement drugs category.
• Vyjuvek™ (beremagene geperpavec) — precertification is required effective August 11, 2023.

Submitting precertification requests
Be sure to submit precertification requests at least two weeks in advance. To save time, request precertification online. Doing so is fast, secure and simple.

You can submit most requests online through our Availity provider portal.* Or you can use your practice’s Electronic Medical Record (EMR) system if it’s set up for electronic precertification requests. Use our “Search by CPT® code” search function on our precertification lists page to find out if the code requires precertification.**

Are you asking for precertification on a specialty drug for a commercial or Medicare member? Then submit your request through Novologix®, also available on Availity®. Not registered for Availity? Go to Availity to register and learn more.

Our annual transition to the new edition of the Milliman Care Guidelines® (MCG)
We use evidence-based clinical guidelines from nationally recognized authorities, such as MCG Health, to make utilization management (UM) decisions.

Every year, we coordinate with MCG Health to update to the latest MCG edition. Starting April 29, 2023, we started using the 27th edition of the MCG and will continue to use it for designated reviews.