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.
- 5.50.017 Cannabinoids
- 5.50.021 H. pylori Infection Agents
- 5.50.022 Amitiza (lubiprostone)
- 5.50.023 Linzess (linaclotide)
- 5.50.024 Motegrity (prucalopride)
- 5.50.026 Ibsrela (tenapanor)
- 5.50.028 Barhemsys (amisulpride)
- 5.50.029 Mytesi (crofelemer)
- 5.50.030 Chenodal (chenodiol)
- 5.50.031 Bylvay (odevixibat)
- 5.50.032 Livmarli (maralixibat)
- 5.50.033 Dartisla ODT (glycopyrrolate)
- 5.50.034 Rebyota
- 5.50.035 Vowst (fecal microbiota, live-brpk)
- 5.50.036 Vibrant System
- 5.50.037 Velsipity (etrasimod)
- 5.50.038 Voquezna (vonoprazan)
- 5.50.039 Zymfentra (infliximab-dyyb)
- 5.50.040 Iqirvo (elafibranor)
- 5.55.001 Procysbi (cysteamine bitartrate)
- 5.55.002 Oxlumo (lumasiran)
- 5.55.003 Tiopronin
- 5.55.004 Filspari (sparsentan)
- 5.55.005 Rivfloza (nedosiran)
- 5.60.001 Tecfidera Bafiertam Vumerity
- 5.60.002 Ampyra (dalfampridine)
- 5.60.003 Nuplazid (pimavanserin)
- 5.60.004 MS Injectables
- 5.60.005 Xyrem (sodium oxybate)
- 5.60.006 Orexin Antagonists
- 5.60.007 Rozerem (ramelteon)
- 5.60.008 Gilenya Tascenso ODT (fingolimod)
- 5.60.009 Aubagio (teriflunomide)
- 5.60.010 Hetlioz (tasimelteon)
- 5.60.011 Sedative Hypnotics
- 5.60.012 Xenazine (tetrabenazine)
- 5.60.013 Tysabri (natalizumab)
- 5.60.014 Provigil Nuvigil
- 5.60.015 Austedo (deutetrabenazine)
- 5.60.023 Lemtrada (alemtuzumab)
- 5.60.024 Amphetamines
- 5.60.025 Methylphenidate Dexmethylphenidate
- 5.60.026 Zyprexa Relprevv (olanzapine)
- 5.60.027 Nuedexta (dextromethorphan quinidine)
- 5.60.028 Ocrevus (ocrelizumab)
- 5.60.029 Ingrezza (valbenazine)
- 5.60.030 Lucemyra (lofexidine)
- 5.60.031 Inbrija (levodopa inhalation powder)
- 5.60.033 Spravato (esketamine nasal spray)
- 5.60.034 Mayzent (siponimod)