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.
- 5.70.014 Krystexxa (pegloticase)
- 5.70.016 Maxalt (rizatriptan)
- 5.70.018 Orencia (abatacept)
- 5.70.021 Subsys (fentanyl sublingual spray)
- 5.70.023 Migraine Powders
- 5.70.024 Xeljanz (tofacitinib)
- 5.70.026 Anti-inflammatory Pain Powders
- 5.70.027 Enbrel (etanercept)
- 5.70.028 Ketamine Powder
- 5.70.029 Humira (adalimumab)
- 5.70.032 Suboxone Drug Class
- 5.70.037 Methotrexate Injections
- 5.70.041 Methadone
- 5.70.045 Sprix (ketorolac)
- 5.70.049 Anesthetic Powders
- 5.70.050 Kineret (anakinra)
- 5.70.051 Simponi / Simponi Aria (golimumab)
- 5.70.053 Otezla (apremilast)
- 5.70.054 Lidocaine injection
- 5.70.057 Fentanyl Powder
- 5.70.058 Butalbital Analgesics
- 5.70.060 Dihydroergotamine Nasal Sprays
- 5.70.061 Opioid Drugs
- 5.70.062 Kevzara (sarilumab)
- 5.70.064 Buprenorphine and Methadone Powders
- 5.70.065 Zilretta (triamcinolone)
- 5.70.066 Opioid Cough Medications
- 5.70.068 Migraine Calcitonin Gene-Related Peptide (CGRP) Antagonists SC
- 5.70.069 Olumiant (baricitinib)
- 5.70.072 Uloric (febuxostat)
- 5.70.073 Dsuvia (sufentanil)
- 5.70.074 Rinvoq (upadactinb)
- 5.70.076 Gloperba (colchicine)
- 5.70.077 Migraine CGRP Antagonists Oral
- 5.70.081 Migraine CGRP Antagonists IV
- 5.70.082 Elyxyb (celecoxib)
- 5.70.083 Olinvyk (oliceridine)
- 5.70.085 Migraine Calcitonin Gene-Related Peptide (CGRP) Antagonists Nasal
- 5.75.001 Botox (onabotulinum toxin A)
- 5.75.002 Dysport (abobotulinum toxin A)
- 5.75.003 Myobloc (rimabotulinumtoxin B)
- 5.75.004 Xeomin (incobotulinumtoxin A)
- 5.75.005 Sabril Vigadrone (vigabatrin)
- 5.75.006 Topiramate Powder
- 5.75.007 Soma (carisoprodol)
- 5.75.008 Cyclobenzaprine powder
- 5.75.009 Hyaluronic Acid Derivatives
- 5.75.010 Hyaluronate Powder
- 5.75.011 Baclofen powder
- 5.75.012 Tizanidine Powder