Aetna Adds Recently Approved Drugs to Precertification List

Aetna has made available four specialty drugs that were approved early in 2022 through prior authorization. These include a biosimilar, a CAR-T immunotherapy, and therapies for macular degeneration and a rare auto-immune disease.

Aetna has added several new-to-market drugs to it precertification list for both commercial and Medicare members. This requires physicians to submit requests two weeks in advance for coverage review.

A spokesperson for CVS Caremark, said new treatments coming to market for chronic, often complex, specialty conditions, help expand options for people living with them. (Aetna was acquired by CVS Health in 2018.)

"However, utilization management plays an important role in helping to make these treatments affordable for employers and members," the spokesperson told Formulary Watch. "When a new high-cost specialty drug comes to market, it is part of CVS Health and Aetna’s standard process to evaluate available evidence for appropriate management, which may include a pre-certification requirement."

Effective May 1, 2022:

• Vabysmo (faricimab): The FDA approved Genentech’s Vabysmo in January 2022 to treat patients with neovascular or “wet” age-related macular generation and diabetic macular edema, two leading causes of vision loss worldwide. It is the first bispecific antibody for the eye. The list price for this therapy is $2,190 per treatment. Aetna says this is part of the ophthalmic medical injectables drug category.

• Enjaymo (sutimlimab-jome): Developed by Sanofi, Enjaymo was approved in February 2022 as the first treatment to decrease the need for red blood cell transfusion due to hemolysis in adults with cold agglutinin disease (CAD), a rare autoimmune disease. Enjaymo is a humanized monoclonal antibody that is designed to selectively target and inhibit C1s in the classical complement pathway, which is part of the innate immune system. The list price is $1,800 per vial. Aetna indicated precertification is required for the drug and site of care.

Effective May 25, 2022:

• Releuko (filgrastim-ayow): This biosimilar was approved in March 2022. Developed by Amneal Pharmaceuticals in collaboration with Kashiv Biosiences, Releuko is a biosimilar to Neupogen and is used to decrease infection after chemotherapy. Aetna indicated this is part of the granulocytecolony stimulating factor drugs category. GoodRx lists a price as low as $226.98, compared with $329.41 for Neupogen.

Effective May 27, 2022:

• Carvykti (cilcabtagene autoleucel): Developed by Janssen, Carvykti is chimeric antigen receptor T-cell (CAR-T) immunotherapy approved by the FDA in February 2022. It is used to treat patients with relapsed or refractory multiple myeloma. Carvykti has a list price of $465,000 for a one-time infusion. It is only available in a limited number of hospitals that are certified to offer the treatment.