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Geisinger Health Plan November 2017 Pharmaceutical Policy Updates

Click here to view the Geisinger Health Plan Pharmaceutical Policy Updates »

Pharmaceutical Policy Updates:

Whats New:

  • MBP 40.0 Orencia IV (abatacept)- New Indication
  • MBP 50.0 Vectibix (panitumumab)- Revised Criteria
  • MBP 76.0 Actemra IV (tocilizumab)- Revised Criteria
  • MBP 106.0 Injectable Antipsychotic Medications- New Indication
  • MBP 126.0 Opdivo (nivolumab)- New Indication
  • MBP 128.0 Blincyto (blinatumomab)- Revised criteria
  • MBP 152.0 Bavencio (avelumab)- New Indication
  • MBP 155.0 Ocrevus (ocrelizumab)- Revised Criteria
  • MBP 157.0 Brineura (cerliponase alfa)- New Policy
  • MBP 158.0 Tepadina (thiotepa)- New Policy

The following policies have been reviewed with no change to the policy section. Additional references or background information was added to support the current policy;

  • MBP 59.0 White Blood Cell Stimulating Factors
  • MBP 78.0 Istodax (romidepsin)
  • MBP 110.0 Xofigo (radium Ra 223 dichloride)
  • MBP 114.0 Vimizim (elosulfase alfa)
  • MBP 120.0 Sylvant (siltuximab)
  • MBP 121.0 Dalvance (dalbavancin)
  • MBP 122.0 Sivextro (tedizolid phosphate) IV
  • MBP 136.0 Imlygic (talimogene laherparepvec)
  • MBP 137.0 Yondelis (trabectedin)
  • MBP 138.0 Onivyde (irinotecan liposome injection)
  • MBP 140.0 Empliciti (elotuzumab)
  • MBP 80.0 Xiaflex (collagenase clostridium histolyticum)


Click here to view the Geisinger Health Plan Pharmaceutical Policy Updates »


Policy Alerts monitors Commercial and Medicare medical policies for changes. While Payers typically update medical policies annually, there are many reasons why a Payer might review or update a policy. When reviews occur out of cycle, they may go unnoticed. Policy Alerts keeps you informed of upcoming and unexpected coverage changes affecting your product. Quickly understanding the changes Payers make can help you adjust reimbursement strategies impacting your business.

Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on Payer decisions in real-time. Whenever changes occur, email notifications containing a summary of those changes are delivered to your inbox. Clients can access detailed coverage reports and medical policies on the interactive Dashboard portal. Save time and keep focused on the important Payer medical policy reviews and coverage decisions affecting your product!

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Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.

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