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.
- 5.75.013 Gabapentin Powder
- 5.75.014 Exondys 51 (eteplirsen)
- 5.75.015 Spinraza (nusinersen)
- 5.75.016 Emflaza (deflazacort)
- 5.75.017 Gabapentin (Gralise*, Horizant*, Neurontin)
- 5.75.018 Lyrica (pregabalin)
- 5.75.019 Savella (milnacipran)
- 5.75.020 Radicava (edaravone)
- 5.75.021 Amantadine Extended-Release
- 5.75.022 Epidiolex (cannabidiol)
- 5.75.023 Onpattro (patisiran)
- 5.75.024 Diacomit (stiripentol)
- 5.75.025 Tegsedi (inotersen)
- 5.75.026 Firdapse (amifampridine)
- 5.75.027 Zolgensma (onasemnogene abeparvovec-xioi)
- 5.75.028 Vyndaqel Vyndamax (tafamidis)
- 5.75.029 Baclofen Oral
- 5.75.030 Exservan (riluzole)
- 5.75.031 Vyondys 53 (golodirsen)
- 5.75.032 Xcopri (cenobamate)
- 5.75.033 Evrysdi (risdiplam)
- 5.75.034 Viltepso (viltolarsen)
- 5.75.035 Amondys 45 (casimersen)
- 5.75.036 Ztalmy (ganaxolone)
- 5.75.037 Amvuttra (vutrisiran)
- 5.75.038 Relyvrio (sodium phenylbutyrate and taurursodiol) powder for suspension
- 5.75.039 Daybue (trofinetide) oral solution
- 5.75.040 Skyclarys (omaveloxolone) capsules
- 5.75.041 Qalsody (tofersen)
- 5.75.042 Elevidys (delandistrogene moxeparvovec-rokl)
- 5.75.043 Agamree (vamorolone)
- 5.75.044 Wainua (eplontersen)
- 5.75.045 Duvyzat (givinostat)
- 5.80.001 Medical Foods
- 5.85.001 Aranesp (darbepoetin alfa)
- 5.85.002 Berinert (C1 esterase inhibitor)
- 5.85.003 Ceprotin (protein C)
- 5.85.004 Cerezyme (imiglucerase)
- 5.85.005 Cinryze (C1 esterase inhibitor human)
- 5.85.006 Epoetin alfa
- 5.85.007 Kalbitor (ecallantide)
- 5.85.008 Leukine (sargramostim)
- 5.85.009 Neulasta Fulphila Fylnetra Nyvepria Stimufend Udenyca Ziextenzo
- 5.85.010 Neupogen Granix Nivestym Releuko Zarxio
- 5.85.011 Soliris (eculizumab)
- 5.85.012 VPRIV (velaglucerase alfa)
- 5.85.014 Elelyso (taliglucerase alfa)
- 5.85.015 Promacta, Alvaiz (eltrombopag)
- 5.85.017 Ruconest (C1 esterase inhibitor recombinant)
- 5.85.018 Cerdelga (eliglustat)