Click here to view the Humana Medical Policy Updates Updates » January 2025 Humana Medical…
BCBS Louisiana Medical Policy Updates – January 2025
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Click here to view the Blue Cross Blue Shield BCBS Louisiana Medical Policy Updates »
January 2025 BCBS Louisiana Medical Policy Updates:
- Ablation of Peripheral Nerves to Treat Pain
- adalimumab (Humira®)
- Adjunctive Techniques for Screening and Surveillance of Barrett Esophagus and Esophageal Dysplasia
- Adlarity (donepezil patch)
- Amniotic Membrane and Amniotic Fluid
- Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening
- Applied Behavior Analysis for Autism Spectrum Disorder in Adults
- Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
- Baroreflex Stimulation Devices
- Bempedoic Acid Products (Nexletol™, Nexlizet™)
- betibeglogene autotemcel (Zynteglo )
- Bimatoprost Implant (Durysta™)
- Bioengineered Skin and Soft Tissue Substitutes
- Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting
- cerliponase alfa (Brineura®)
- Chimeric Antigen Receptor T-cell (CAR-T) Therapy
- Cialis® 5 mg, generics (tadalafil)
- Continuous Glucose Monitoring
- dalfampridine (Ampyra®, generics)
- Daprodustat (Jesduvroq™)
- Dhivy™ (carbidopa/levodopa)
- Erythropoiesis-Stimulating Agents (ESA’s): epoetin alfa (Epogen® and Procrit®), epoetin alfa-epbx (Retacrit™), darbepoetin alfa (Aranesp®), and pegylated epoetin beta (Mircera®)
- Etranacogene Dezaparvovec (Hemgenix®)
- Exagamglogene Autotemcel (Casgevy™)
- Experimental-Investigational Services
- Focal Treatments for Prostate Cancer
- Formulary Exception Process/Non-Formulary Drug Review Process Standard Criteria (Closed Formulary)
- GLP-1 Agonists for Diabetes
- Hematopoietic Cell Transplantation for Autoimmune Diseases
- Immune Globulin Therapy
- Immune Prophylaxis for Respiratory Syncytial Virus
- infliximab (Remicade®
- infliximab-abda (Renflexis®)
- Infliximab-axxq (Avsola®)
- infliximab-dyyb (Inflectra®)
- Interferon gamma-1b (Actimmune®)
- lanadelumab-flyo (Takhzyro™)
- Lodoco®(colchicine)
- luspatercept-aamt (Reblozyl®)
- Magnetic Resonance-Guided Focused Ultrasound
- Magnetoencephalography/Magnetic Source Imaging
- maralixibat oral solution (Livmarli™)
- Mechanical Stretch Devices for Joint Stiffness and Contractures
- migalastat (Galafold™)
- Miscellaneous Genetic and Molecular Diagnostic Tests
- Nadofaragene Firadenovec-vncg (Adstiladrin®)
- Ocrelizumab (Ocrevus™)
- Opioid Management/Long Acting Oral Opioid Step Therapy
- Pegcetacoplan (Syfovre™)
- Peripheral Subcutaneous Field Stimulation
- Pitolisant (Wakix®)
- Plasma Exchange (PE)
- Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
- Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Resistant Hypertension
- Ritlecitinib (Litfulo™)
- sapropterin dihydrochloride (Kuvan®, generics)
- Scintimammography and Gamma Imaging of the Breast and Axilla
- Select Anti-Epileptic Drugs
- Select Dexamethasone Packs
- Select Erectile Dysfunction Medications
- Select Hemophilia Products
- Select Muscle Relaxants
- Select Ophthalmic Prostaglandins
- Select Topical Rosacea Products
- Sodium-Glucose Co-Transporter-2 (SGLT-2) Inhibitors and Combination Products
- Temporarily Implanted Nitinol Device (iTind) for Benign Prostatic Hyperplasia
- tezacaftor/ivacaftor (Symdeko™)
- tildrakizumab-asmn (Ilumya™)
- tolvaptan (Jynarque™)
- Topical Corticosteroids
- Trastuzumab Products
- triamcinolone extended release intra-articular injection (Zilretta™)
- Ustekinumab (Stelara®)
- Vigabatrin Products
- Zoryve™ (roflumilast cream)
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