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Premera Blue Cross Medical Policy Updates – April 2024
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April 2024 Medical Policy Updates
- Allogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias
- Ambulance and Medical Transport Services
- Amniotic Membrane and Amniotic Fluid
- Antibody-Drug Conjugates
- Antidepressants: Pharmacy Medical Necessity Criteria for Brands
- Bioengineered Skin and Soft Tissue Substitutes
- Botulinum Toxins
- BRAF and MEK Inhibitors
- Bruton’s Kinase Inhibitors
- C3 and C5 Complement Inhibitors
- Chimeric Antigen Receptor Therapy for Leukemia and Lymphoma
- Chimeric Antigen Receptor Therapy for Multiple Myeloma
- Cosmetic and Reconstructive Services
- Cutaneous T-Cell Lymphomas (CTCL): Systemic Therapies
- Drugs for Rare Diseases
- Durable Medical Equipment
- Durable Medical Equipment Repair/Replacement
- Epidermal Growth Factor Receptor (EGFR) Inhibitors
- Folate Antimetabolites
- Gene Therapy for Inherited Retinal Dystrophy
- Gonadotropin Releasing Hormone (GnRH) Analogs
- Hearing Aids (Excludes Implantable Devices)
- Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia
- Hematopoietic Cell Transplantation for Acute Myeloid Leukemia
- Hematopoietic Cell Transplantation for Autoimmune Diseases
- Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma
- Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
- Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia
- Hematopoietic Cell Transplantation for Hodgkin Lymphoma
- Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults
- Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome
- Hematopoietic Cell Transplantation for Primary Amyloidosis
- Hematopoietic Cell Transplantation for Solid Tumors of Childhood
- Hematopoietic Cell Transplantation for Waldenström Macroglobulinemia
- Hematopoietic Cell Transplantation in the Treatment of Germ-Cell Tumors
- Herceptin® (trastuzumab) and Other HER2 Inhibitors
- Hospital Beds and Accessories
- Intravenous Iron Replacement Products
- Knee Arthroscopy in Adults
- Medical Necessity Criteria and Dispensing Quantity Limits for Exchange Formulary Benefits
- Medical Necessity Criteria for Pharmacy Edits
- Microprocessor-Controlled and Powered Prostheses and Orthoses for the Lower Limb
- Miscellaneous Oncology Drugs
- Monoclonal Antibodies for the Treatment of Lymphoma
- Myoelectric Prosthetic and Orthotic Components for the Upper Limb
- Non-covered Experimental/Investigational Services
- Oral Iron Chelating Agents
- Orthopedic Applications of Stem Cell Therapy (Including Allografts and Bone Substitutes Used with Autologous Bone Marrow)
- Pharmacologic Treatment of Atopic Dermatitis
- Pharmacologic Treatment of Neuropathy, Fibromyalgia, and Seizure Disorders
- Pharmacologic Treatment of Psoriasis
- Pharmacotherapy of Arthropathies
- Pharmacotherapy of Cushing’s Disease and Acromegaly
- Pharmacotherapy of Inflammatory Bowel Disorder
- Pharmacotherapy of Multiple Sclerosis
- Pharmacotherapy of Perinatal/Infantile and Juvenile-Onset Hypophosphatasia (HPP)
- Phosphate Binders
- Prescription Digital Therapeutics
- Preventive Care
- Prostate Cancer Targeted Therapies
- Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases
- Site of Service: Infusion Drugs and Biologic Agents
- Stem Cell Therapy for Peripheral Arterial Disease
- Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders
- Vascular Endothelial Growth Factor (VEGF) Receptor Inhibitors for Ocular Disorders
Click here to view the Premera Blue Cross Medical Policy Updates »
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