Florida Blue Cross Blue Shield March 2018 Medical Policy Updates

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March 2018 Medical Policy Updates:

New:

• Abemaciclib (Verzenio)
• Acalabrutinib (Calquence) Oral
• Axicabtagene Ciloleucel (Yescarta) Infusion
• Voretigene Neparvovec-rzyl (Luxturna) Injection

Revised:

• Afatinib (Gilotrif TM) Tablets– Revision to guideline, consisting of adding NCCN updates to position statement.
• Allergy Testing and Immunotherapy– Revision: added criteria for aspirin desensitization; revised Reimbursement Information section; updated references.
• Amniotic Membrane and Limbal Stem Cell Transplantation for the Treatment of Ocular Conditions– Scheduled review. Maintained position statement; updated references.
• Apheresis, Plasmapheresis and Plasma Exchange– Revision: added CAR T-cell therapy as a covered indication. Updated references.
• Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer– Review; position statements maintained; description section, coding, and references updated.
• Bioimpedance Devices for Detection and Management of Lymphedema– Review; Investigational position maintained; description, position statement, and references updated.
• Bortezomib (Velcade®) Injection– Revision to guidelines consisting of updating description, position statement, dosage/administration, precautions, coding/billing, and references based on a newly approved bortezomib product manufactured by Fresenius Kabi.
• Brentuximab (Adcetris™) Injection– Revision to guideline; consisting of updating position statement, coding, and references.
• Buprenorphine HCl (Probuphine ®) Subdermal Implant– Revision to guideline; consisting of updating position statement to include Sublocade.
• Clotting Factors and Coagulant Blood Products– Revision to guideline; consisting of updating position statement to include Hemlibra.
• Computed Tomography (CT) Abdomen and Pelvis– Revision; revised position statements (abdomen, pelvis, abdomen and pelvis). Updated definitions and references.
• Computed Tomography (CT) Extremity (Upper and Lower)– Revision; revised position statement (upper and lower extremity). MCG subject: Changed “Computerized” to “Computed” and removed “Axial”. Updated definitions and references.
• Computed Tomography (CT) Head and Brain– Revision; revised position statement. Added position statement for seizure disorder, neurologic symptoms or deficits, cognitive impairment, inflammatory disease or infection, normal pressure hydrocephalus, combination CT. Updated references.
• Computed Tomography (CT) of the Neck for Soft Tissue Evaluation– Revision; revised position statement. Added position statement for tumor, cancer, mass, combination studies, inflammatory disease or infection, and pre/post-operative evaluation. Updated references.
• Computed Tomography (CT) Spine (Cervical, Thoracic, Lumbar)– Revision; revised position statement. MCG subject: Changed “Computerized” to “Computed” and removed “Axial”. Updated references.
• Computed Tomography (CT) Temporal Bone/Mastoid & Maxillofacial– Revision; revised position statement (temporal bone and mastoid, maxillofacial & sinus, orbit and sella). Added position statement for combination studies and internal auditory canal. Updated references.
• Computed Tomography (CT) Thorax (Chest)– Revision; revised position statement. Added position statement for vascular disease. Updated references.
• Drugs and Biologics without Medical Coverage Guideline– Revision to guideline; consisting of adding Macrilen, Mepsevii, Zilretta to Position Statement.
• Enasidenib Mesylate (Idhifa®) Tablet– Revision to guidelines consisting of updating the description section, position statement, and references based on the revised NCCN Guidelines for AML.
• Erlotinib (Tarceva®) Tablets– Revision to guideline to include NCCN update.
• Gefitinib (Iressa)– Revision to guidline, consisting of adding NCCN updates to position statement.
• Growth Hormone Therapy– Review and revision to guideline; consisting of updating the position statement; updated dosing, precautions and references.
• Home Spirometry– Review; investigational position maintained; description, position statement, and references updated.
• Human EGFR Inhibitors (Cetuximab [Erbitux®], Panitumumab [Vectibix®])– Revision to guideline consisting of updating position statement and references.
• Immune Globulin Therapy– Revision to guideline; consisting of updating position statement, coding and references.
• Investigational Services– Added codes 90875, 90876.
• Irinotecan Liposome Injection (Onivyde™)– Review and revision to guideline consisting of updating position statement, coding and references.
• Irreversible Electroporation (IRE)– Scheduled review. Position statement maintained; updated references.
• Lenalidomide (Revlimid®)– Revision of guidelines consisting of clarifying the position statement for MM dosage and use in non-GBD DLBCL.
• Nivolumab (Opdivo®)– Revision to guideline; consisting of updating position statement, coding and references.
• NK-1 receptor antagonist injectable therapy (Emend®, Cinvanti®, Varubi®)– Review and revision to guideline consisting of updating position statement, description, dosing, coding and references.
• Non-Covered Services– Added codes 90845, 90882, 90889.
• Obeticholic Acid (Ocaliva®) Tablet– Revision to guidelines consisting of updating the description section, position statement, other section, and references based on a revised product label including a new Boxed Warning and dosage recommendations.
• Olaparib (Lynparza TM)– Revision to guideline; consisting of updating position statement, description, dosing, and references.
• Olaratumab (Lartruvo)– Revision to guideline consisting of updating position statement, coding and references.
• Palonosetron Hydrochloride (Aloxi®)– Update to coding.
• Pembrolizumab (Keytruda®) Injection– Revision to guideline; consisting of updating position statement, coding and references.
• Plugs for Fistula Repair– Review; investigational position maintained; description, position statement, and references updated.
• ProThelial for the Treatment of Oral Mucositis– Annual review; investigational position maintained and references updated.
• Rituximab (Rituxan) and Rituximab hyaluronidase (Rituxan Hycela)– Revision to guideline; consisting of updating position statement, coding and references.
• Ruxolitinib (Jakafi ™) Oral– Review and revision to guideline; consisting of updating position statement and references.
• Tiopronin (Thiola®) Tablet– Review and revision to guideline; consisting of updating references.
• Transanal Endoscopic Microsurgery (TEM)– Review; Position statements maintained; description, coding, and references updated.
• Vemurafenib (Zelboraf™)– Revision to guideline; consisting of updating position statement, coding and references.
• Venetoclax (Venclexta®) Tablet– Revision to guideline consisting of updating the description section and references based on updated NCCN Guidelines for CLL/SLL.

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

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