BCBS Louisiana Medical Policy Updates – July 2019

July 2019 BCBS Louisiana Medical Policy Updates: 

• Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms
• Chromosomal Microarray Testing for the Evaluation of Pregnancy Loss
• Cryosurgical Ablation of Breast Fibroadenomas
• Cryosurgical Ablation of Primary or Metastatic Liver Tumors
• denosumab (Prolia)
• Endovascular Stent Grafts for Abdominal Aortic Aneurysms
• Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)
• Extended Release Topiramate Products
• External Insulin Pump
• Fentanyl Oral Transmucosal and Nasal Opioid Analgesics
• Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management
• Genetic Cancer Susceptibility Panels Using Next Generation Sequencing
• Genetic Testing for Dilated Cardiomyopathy
• Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
• Genetic Testing for Neurofibromatosis
• Genotyping for 9p21 Single Nucleotide Polymorphisms to Predict Risk of Cardiovascular Disease or Aneurysm
• Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma
• Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer
• Implantable Hormone Pellets
• Implantation of Intrastromal Corneal Ring Segments
• Ingestible pH and Pressure Capsule
• Insulins (Non-Long Acting Products)
• Laboratory Tests for Heart Transplant Rejection
• Molecular Panel Testing of Cancers to Identify Targeted Therapies
• Coronary Computed Tomography Angiography With Selective Noninvasive Fractional Flow Reserve
• Occipital Nerve Stimulation
• Oral Non-Sedating Antihistamines and Singulair Products (Branded)
• Percutaneous Tibial Nerve Stimulation
• pramlintide (Symlin)
• Proprotein Convertase Subtilisin Kexin Type 9 (PCSK9) Inhibitors [alirocumab (Praluent), evolocumab (Repatha)]
• Repository Corticotropin Injection (ACTH Gel, H.P. Acthar Gel)
• rituximab (Rituxan), rituximab and hyaluronidase, human (Rituxan Hycela)
• Sacral Nerve Neuromodulation/Stimulation
• Select Inhaled Respiratory Agents
• Serum Antibodies for the Diagnosis of Inflammatory Bowel Disease
• Sinus Ostial Dilatation with Balloon Catheter for Rhinosinusitis
• Stem-cell Therapy for Peripheral Arterial Disease
• tesamorelin (Egrifta)
• Tetracyclines (oral)
• Topical Acne Products
• Transcatheter Aortic Valve Implantation for Aortic Stenosis
• Transcatheter Mitral Valve Repair
• Transtympanic Micropressure Applications as a Treatment of Meniere Disease
• Treatment of Hyperhidrosis
• Trulance (plecanatide)
• Drug Testing in Pain Management and Substance Abuse Treatment
• Viscocanalostomy and Canaloplasty
• Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders
• Daxbia (cephalexin)
• Ryvent (carbinoxamine)
• Rhofade (oxymetazoline)
• Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment
• Molecular Testing in the Management of Pulmonary Nodules
• Symproic (naldemedine)
• emicizumab (Hemlibra)
• Naltrexone Implants/Pellets
• Treatment of Hepatitis C with Pegylated Interferon, Ribavirin and/or Telaprevir (Incivek) and Boceprevir (Victrelis)-Replaced Policy
• Balloon Dilation of the Eustachian Tube
• Trimpex (trimethoprim oral solution)
• Lyrica CR (pregabalin)
• vestronidase alfa-vjbk (Mepsevii)
• tezacaftor/ivacaftor (Symdeko)
• L-Glutamine (Endari)
• Gene Expression Profiling for Cutaneous Melanoma
• Sensipar  (cinacalcet)
• Restasis  (cyclosporine ophthalmic)

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

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