Medical Policies
Policies that are included in the FEP Medical Policy Manual.
The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. They are not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. The Blue Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy, to recommend, advocate, encourage or discourage any particular medical technologies. Medical decisions relative to medical technologies are to be made strictly by members/patients in consultation with their health care providers. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that the Blue Cross and Blue Shield Service Benefit Plan covers (or pays for) this service or supply for a particular member.
- 5.40.017 Remodulin (treprostinil)
- 5.40.018 Tracleer (bosentan)
- 5.40.019 Adempas (riociguat)
- 5.40.020 Opsumit (macitentan)
- 5.40.021 Orenitram (treprostinil)
- 5.40.022 Cialis (tadalafil)
- 5.40.023 PDE5 Inhibitor powders
- 5.40.024 Phentolamine Powder
- 5.40.025 Papaverine Powder
- 5.40.026 Cholestyramine Powder
- 5.40.027 Nexletol (bempedoic acid), Nexlizet (bempedoic acid and ezetimibe)
- 5.40.028 Tikosyn (dofetilide)
- 5.40.029 Verquvo (vericiguat)
- 5.40.030 Evkeeza (evinacumab-dgnb)
- 5.40.031 Entadfi (finasteride and tadalafil)
- 5.40.032 Leqvio (inclisiran)
- 5.40.033 Camzyos (mavacamten)
- 5.40.034 Furoscix (furosemide)
- 5.40.035 Inpefa (sotagliflozin)
- 5.40.036 Winrevair (sotatercept-csrk)
- 5.40.037 Opsynvi (macitentan and tadalafil)
- 5.45.001 Pulmozyme (dornase alfa)
- 5.45.002 Xolair (omalizumab)
- 5.45.003 Kalydeco (ivacaftor)
- 5.45.004 Esbriet (pirfenidone)
- 5.45.005 Ofev (nintedanib)
- 5.45.006 Orkambi (lumacaftor ivacaftor)
- 5.45.007 IL-5 Antagonists (IgG1 kappa)
- 5.45.008 Cinqair (reslizumab)
- 5.45.009 Alpha1 Proteinase Inhibitors
- 5.45.010 Symdeko (tezacaftor ivacaftor)
- 5.45.011 Sinus Implants
- 5.45.012 Trikafta (elexacaftor tezacaftor ivacaftor)
- 5.45.013 Xhance (fluticasone)
- 5.45.014 Bronchitol (mannitol)
- 5.45.015 Tezspire (tezepelumab-ekko)
- 5.50.001 Proton Pump Inhibitors
- 5.50.002 Infliximab
- 5.50.003 Gattex (teduglutide)
- 5.50.005 NK1 Antagonists
- 5.50.006 Opioid Antagonist Drug Class
- 5.50.007 Viberzi (eluxadoline)
- 5.50.009 Cholbam (cholic acid)
- 5.50.010 Ocaliva (obeticholic acid)
- 5.50.011 Cimzia (certolizumab pegol)
- 5.50.012 Entyvio
- 5.50.013 Trulance (plecanatide)
- 5.50.014 Xermelo (telotristat ethyl)
- 5.50.015 5-HT3 Antagonists
- 5.50.016 Doxylamine Pyridoxine