Changes to our National Precertification List (NPL) 

This update applies to both our commercial and Medicare members, unless otherwise noted. Effective January 1, 2024, we’ll require precertification for the following drugs: 

• Zilretta® (triamcinolone acetonide extended-release injectable suspension) — precertification is required for Medicare members only. 
• Pemfexy® (pemetrexed) — precertification is required for Medicare members only. 
• Rivfloza™ (nedosiran) 
• Daxxify™ (daxibotulinumtoxin A) — this drug is part of the botulinum toxin category. 
• Pombiliti™ (cipaglucosidase alfa-atga) — this drug is part of the enzyme replacement category. 
• Tofidence™ (tocilizumab-bavi) — this drug is part of the immunologic agents category. 
• Cosentyx IV® (secukinumab) — this drug is part of the immunologic agents category. 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. If you need precertification for a specialty drug for a commercial or Medicare member, submit your request through Novologix®, also available on Availity®.

Precertification Lists 

Precertification – Health Care Professionals