BCBS Florida Medical Policy Updates – January 2023

Click here to view the Blue Cross Blue Shield BCBS Florida Medical Policy Updates »

January 2023 BCBS Florida Medical Policy Updates:

• Abatacept (Orencia) Injection and Infusion
• Adalimumab (Humira) Injection
• Anakinra (Kineret®) Injection
• Apremilast (Otezla®) Tablet
• Bariatric Surgery
• Baricitinib (Olumiant ®) Tablet
• Betibeglogene Autotemcel (Zynteglo ) IV
• Bevacizumab (Avastin), bevacizumab-awwb (Mvasi), bevacizumab-bvzr (Zirabev), and bevacizumab-maly (Alymsys) Injection
• Bio-Engineered Skin and Soft Tissue Substitutes; Amniotic Membrane and Amniotic Fluid
• Bone Mineral Density Studies
• Bortezomib Injection
• Brand Tecfidera®, Diroximel fumarate (Vumerity™), Monomethyl fumarate (Bafiertam) Capsule
• Brodalumab (Siliq®) Injection
• Cardiac Monitoring Devices
• Certolizumab Pegol (Cimzia®) Injection
• Cladribine (Mavenclad®) tablets
• Dupilumab (Dupixent®) Injection
• Elivaldogene autotemcel (Skysona)
• Enteral Formulas
• Etanercept (Enbrel®) Injection
• External Insulin Infusion Pumps and Continuous Glucose Monitors
• Fecal Microbiota Transplantation
• Fingolimod (Gilenya™) Capsule
• Genetic Testing
• Golimumab (Simponi®, Simponi® Aria) Injection and Infusion
• Gonadotropin Releasing Hormone Analogs and Antagonists
• Granulocyte Colony Stimulating Factors
• Guselkumab (Tremfya®) Injection
• Ibandronate (Boniva®) Injection
• Implantable Bone-Conduction and BoneAnchored Hearing Aids
• Infliximab Products [infliximab (Remicade®),Infliximab, infliximab-dyyb (Inflectra®), infliximab-abda (Renflexis®), and infliximab-axxq (Avsola®)]
• Investigational Services
• Ixekizumab (Taltz) Injection
• Lumbar Spine Surgery
• MCG?mcgId=09-J4000-32&pv=false
• Minimally Invasive Fusion Techniques
• Multiple Sclerosis Self Injectable Therapy (Interferon beta products, Copaxone and Glatopa)
• Nerve Block Injections
• Non-Covered Services
• Ocrelizumab (Ocrevus®) Infusion
• Ofatumumab (Kesimpta)
• Olaratumab (Lartruvo®)
• Oral Oncology Medications
• Orthotics
• Ozanimod (Zeposia ) Capsules
• Pemetrexed Disodium (Alimta®, Pemfexy™) IV
• Ponesimod (Ponvory™) Tablet
• Preventive Services
• Prostate Saturation Biopsy
• Risankizumab-rzaa (Skyrizi) Injection
• Sarilumab (Kevzara) Injection
• Secukinumab (Cosentyx ) Injection
• Siponimod (Mayzent®) Tablets
• Sodium Phenylbutyrate (Buphenyl®)
• Step Therapy Requirements for Medicare Outpatient (Part B) Medications
• Technologies for the Evaluation of Malignant Melanoma
• Teriflunomide (Aubagio®) Tablet
• Tildrakizumab-asmn (Ilumya®) Injection
• Tocilizumab (Actemra ) Injection and Infusion
• Tofacitinib (Xeljanz , Xeljanz  XR) Oral Solution
• Tralokinumab-ldrm (Adbry®) Injection
• Transcranial Magnetic Stimulation
• Transcutaneous Electric Nerve Stimulation (TENS)
• Tumor/Genetic Markers
• Upadacitinib (Rinvoq) Tablets
• Ustekinumab (Stelara) Injection and Infusion
• Vagus Nerve Stimulation
• Vedolizumab (Entyvio®) Infusion
• Viscocanalostomy and Canaloplasty

Pharmacy Updates:

• Abaloparatide (Tymlos™)
• Abemaciclib (Verzenio)
• Acalabrutinib (Calquence) Oral
• Advanced Imaging of the Heart: Echocardiography
• Afatinib (Gilotrif) Tablets
• Alectinib (Alecensa)
• Alpelisib (Piqray) Tablet
• Apalutamide (Erleada) Tablet
• Arterial Ultrasound (Duplex Ultrasounds and Physiologic Testing)
• Avapritinib (Ayvakit)
• Axitinib (Inlyta) Tablets
• Belumosudil (Rezurock™) tablets
• Bexarotene (Targretin) Capsules
• Binimetinib (Mektovi) Tablet
• Botulinum Toxins
• Brigatinib (Alunbrig)
• Cabozantinib Capsules and Tablets (Cometriq, Cabometyx)
• Capecitabine (Xeloda) Tablets
• Ceritinib (Zykadia) Capsules
• Cobimetinib (Cotellic) Tablet
• Corticosteroid Intravitreal Implant
• Crizotinib (Xalkori) Capsules
• Dabrafenib (Tafinlar) Capsules
• Dacomitinib (Vizimpro)
• Darolutamide (Nubeqa) Tablet
• Dasatinib (Sprycel) Tablets
• Diagnostic Coronary Angiography
• Dostarlimab-gxly (Jemperli)
• Durable Medical Equipment (DME)
• Duvelisib (Copiktra)
• Elective Percutaneous Coronary Intervention
• Enasidenib Mesylate (Idhifa) Tablet
• Encorafenib (Braftovi) Capsule
• Entrectinib (Rozlytrek) Capsules
• Enzalutamide (Xtandi) Capsules
• Erdafitinib (Balversa)
• Erlotinib (Tarceva) Tablets
• Everolimus (Afinitor, Afinitor Disperz) Tablets
• Gefitinib (Iressa)
• Genetic Testing
• Gilteritinib (Xospata)
• Glasdegib (Daurismo)
• Gonadotropin Releasing Hormone Analogs and Antagonists
• Hormone Replacement
• Ibandronate (Boniva®) Injection
• Idelalisib (Zydelig) Oral Tablet
• Imatinib Mesylate (Gleevec) Tablets
• Ivosidenib (Tibsovo)
• Lapatinib (Tykerb) Tablets
• Larotrectinib (Vitrakvi)
• Lenalidomide (Revlimid®)
• Lenvatinib (Lenvima)
• Lorlatinib (Lorbrena)
• Luspatercept-aamt (Reblozyl®) Injection
• Midostaurin (Rydapt) Capsule
• Neratinib (Nerlynx)
• New-To-Market Program for ProviderAdministered Medications
• Niraparib (Zejula) Capsule
• Nusinersen (Spinraza™)
• Octreotide Acetate (Sandostatin LAR  Depot, Bynfezia Pen™, Mycapssa Capsule)
• Olaparib (Lynparza)
• Olaratumab (Lartruvo®)
• Omadacycline (Nuzyra ) Tablets
• Onasemnogene abeparvovec (Zolgensma)
• Osimertinib (Tagrisso)
• Palbociclib (Ibrance)
• Panobinostat (Farydak) Capsule
• Patisiran (Onpattro™)
• Pazopanib (Votrient) Tablets
• Pembrolizumab (Keytruda®) Injection
• Pexidartinib (Turalio)
• Pomalidomide (Pomalyst) Capsule
• Ponatinib (Iclusig) Tablets
• Prostate Saturation Biopsy
• Regorafenib (Stivarga) Tablets
• Ribociclib (Kisqali®)
• Risdiplam (Evrysdi™)
• Ropeginterferon alfa-2b-njft (Besremi)
• Rucaparib (Rubraca)
• Ruxolitinib (Jakafi) Tablets
• Selinexor (Xpovio) Tablet
• Sonidegib (Odomzo) Capsule
• Sorafenib (Nexavar) Tablets
• Sunitinib Malate (Sutent) Capsules
• Talazoparib (Talzenna)
• Temozolomide (Temodar) Capsule and Injection
• Temsirolimus (Torisel®) Injection
• Topotecan HCl (Hycamtin) Injection and Capsule®)
• Trametinib (Mekinist) Tablets
• Transcranial Magnetic Stimulation
• Tretinoin Oral Capsules
• Trifluridine-Tipiracil (Lonsurf) Capsule
• Triheptanoin (Dojolvi®) Oral Liquid
• Tumor/Genetic Markers
• Vandetanib (Caprelsa®) Tablets
• Vemurafenib (Zelboraf)
• Venetoclax (Venclexta) Tablet
• Vismodegib (Erivedge) Capsules
• Vorinostat (Zolinza) Capsules
• Zanubrutinib (Brukinsa)

Click here to view the Blue Cross Blue Shield BCBS Florida Medical Policy Updates »

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