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.
- 5.85.019 Zavesca (miglustat)
- 5.85.020 Nplate (romiplostim)
- 5.85.021 Mircera (methoxy polyethylene glycol-epoetin beta)
- 5.85.023 Icatibant
- 5.85.025 Endari (L-glutamine)
- 5.85.026 Haegarda (C1 esterase inhibitor human)
- 5.85.027 Siklos (hydroxyurea)
- 5.85.029 Tavalisse (fostamatinib disodium hexahydrate)
- 5.85.030 Doptelet (avatrombopag)
- 5.85.031 Mulpleta (lusutrombopag)
- 5.85.032 Takhzyro (lanadelumab-flyo)
- 5.85.033 Ultomiris (ravulizumab-cwvz)
- 5.85.034 Cablivi (caplacizumab-yhdp)
- 5.85.035 Reblozyl (luspatercept-aamt)
- 5.85.036 Adakveo (crizanlizumab-tmca)
- 5.85.037 Givlaari (givosiran)
- 5.85.038 Oxbryta (voxelotor)
- 5.85.039 Mozobil (plerixafor)
- 5.85.040 Orladeyo (berotralstat)
- 5.85.041 Nascobal (cyanocobalamin)
- 5.85.042 Empaveli (pegcetacoplan)
- 5.85.043 Tavneos (avacopan)
- 5.85.044 Rethymic (allogeneic processed thymus tissue-agdc)
- 5.85.045 Enjaymo (sutimlimab-jome)
- 5.85.046 Pyrukynd (mitapivat)
- 5.85.047 Rolvedon (eflapegrastim-xnst)
- 5.85.048 Hemgenix
- 5.85.049 Omisirge (omidubicel-onlv)
- 5.85.050 Rystiggo (rozanolixizumab-noli)
- 5.85.051 Roctavian (valoctocogene roxaparvovec-rvox)
- 5.85.052 Aphexda (motixafortide)
- 5.85.053 Jesduvroq (daprodustat)
- 5.85.054 Zilbrysq (zilucoplan)
- 5.85.055 Fabhalta (iptacopan)
- 5.85.057 Casgevy (exagamglogene autotemcel)
- 5.85.058 Lyfgenia (lovotibeglogene autotemcel)
- 5.85.060 Voydeya (danicopan)
- 5.85.061 Xolremdi (mavorixafor)
- 5.85.062 Beqvez (fidanacogene elaparvovec-dzkt)
- 5.85.063 Lenmeldy (atidarsagene autotemcel)
- 5.90.001 Topical Rosacea Agents
- 5.90.002 Tazarotene
- 5.90.003 Tretinoin
- 5.90.004 Stelara (ustekinumab)
- 5.90.006 Regranex (becaplermin)
- 5.90.007 Lidocaine Patches
- 5.90.008 Zyclara (imiquimod)
- 5.90.009 Topical Antifungals
- 5.90.010 Luzu (luliconazole)
- 5.90.011 Cosentyx (secukinumab)