BCBS Louisiana Medical Policy Updates – December 2023

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

December 2023 BCBS Louisiana Medical Policy Updates:

• Abaloparatide (Tymlos™)
• Ablation Procedures for Peripheral Neuromas
• Adjunctive Techniques for Screening and Surveillance of Barrett Esophagus and Esophageal Dysplasia
• Allograft Injection for Degenerative Disc Disease
• Axial Lumbosacral Interbody Fusion
• Beta Interferons for the Treatment of Multiple Sclerosis
• Bisphosphonates (Oral)
• Breast Brachytherapy
• Bronchial Valves
• burosumab (Crysvita®)
• C1 Esterase Inhibitor (Berinert®)
• cladribine (Mavenclad®)
• Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)
• Diabetic Test Strips
• Dipeptidyl Peptidase-4 (DPP-4) Inhibitors, DPP-4 Inhibitor/Metformin Combination Drugs
• Endovascular Therapies for Extracranial Vertebral Artery Disease
• etanercept (Enbrel®)
• Ethacrynic Acid Oral Products (Edecrin®, generics)
• Gene Expression Profiling for Uveal Melanoma
• Gene Variants (PALB2, CHEK2 and ATM) Associated With Breast Cancer in Individuals at High Breast Cancer Risk
• Genetic Testing for Diagnosis and Management of Mental Health Conditions
• Genetic Testing for Familial Cutaneous Malignant Melanoma
• Genetic Testing for Hereditary Hemochromatosis
• Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related Disorders
• Germline Genetic Testing for Pancreatic Cancer Susceptibility Genes
• glatiramer acetate (Copaxone®)
• Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas
• Hip Resurfacing
• Hippotherapy
• itraconazole (Onmel®)
• ivermectin tablets (Stromectol® ,generics)
• Leadless Cardiac Pacemakers
• mepolizumab (Nucala®)
• mifepristone (Korlym®)
• modafinil (Provigil®)/armodafinil (Nuvigil®)
• Molecular Testing for the Management of Pancreatic Cysts or Barrett Esophagus, and Solid Pancreaticobiliary Lesions
• Noncontact Ultrasound Treatment for Wounds
• Oncologic Applications of Photodynamic Therapy, Including Barrett’s Esophagus
• Pegylated Interferons (Pegasys® , PegIntron®) for Other (NonHepatitis C) Uses
• Pharmacotherapy for Gaucher Disease
• Phosphate Binders
• Photodynamic Therapy for Choroidal Neovascularization
• Risk-Reducing Mastectomy
• romosozumab-aqqg (Evenity™)
• Saturation Biopsy for Diagnosis, Staging, and Management of Prostate Cancer
• Select Drug Quantity Management
• Sensory Integration Therapy and Auditory Integration Therapy
• sipuleucel-T (Provenge®
• Surgical Treatments for Breast Cancer−Related Lymphedema
• tafamidis Products (Vyndaqel®, Vyndamax™)
• teriflunomide (Aubagio®)
• Teriparatide Products
• Tetracyclines (oral)
• Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders
• Treatment of Hepatitis C with a sofosbuvir (Sovaldi®) Based Regimen
• Treatment of Hepatitis C with elbasvir and grazoprevir (Zepatier®)
• Treatment of Hepatitis C with glecaprevir/pibrentasvir (Mavyret™)
• Treatment of Hepatitis C with ombitasvir, paritaprevir, ritonavir, and dasabuvir (Viekira Pak™)
• Treatment of Hepatitis C with sofosbuvir/ledipasvir (Harvoni®, Authorized Generic)
• Treatment of Hepatitis C with sofosbuvir/velpatasvir (Epclusa®, Authorized Generic)

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

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