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.
- 5.21.007 Intron A (interferon alfa-2b)
- 5.21.008 Kepivance (palifermin)
- 5.21.009 Provenge (sipuleucel-T)
- 5.21.010 Rituximab
- 5.21.012 Xalkori (crizotinib)
- 5.21.013 Yervoy (ipilimumab)
- 5.21.014 Zelboraf (vemurafenib)
- 5.21.015 Zolinza (vorinostat)
- 5.21.016 Caprelsa (vandetanib)
- 5.21.017 Erwinaze (asparaginase)
- 5.21.018 Jakafi (ruxolitinib)
- 5.21.019 Adcetris (brentuximab vedotin)
- 5.21.020 Perjeta (pertuzumab)
- 5.21.021 Xtandi (enzalutamide)
- 5.21.022 Bosulif (bosutinib)
- 5.21.023 Tykerb (lapatinib)
- 5.21.024 Kyprolis (carfilzomib)
- 5.21.025 Zaltrap (ziv-aflibercept)
- 5.21.026 Stivarga (regorafenib)
- 5.21.027 Jevtana (cabazitaxel)
- 5.21.028 Zytiga (abiraterone acetate)
- 5.21.029 Gazyva (obinutuzumab)
- 5.21.030 Iclusig (ponatinib)
- 5.21.031 Synribo (omacetaxine mepesuccinate)
- 5.21.032 Kadcyla (ado-trastuzumab emtansine)
- 5.21.033 Cometriq (cabozantinib)
- 5.21.034 Inlyta (axitinib)
- 5.21.035 Erivedge (vismodegib)
- 5.21.036 Pomalyst (pomalidomide)
- 5.21.037 Tafinlar (dabrafenib)
- 5.21.038 Mekinist (trametinib)
- 5.21.039 Gilotrif (afatinib)
- 5.21.040 Valchlor (mechlorethamine)
- 5.21.041 Imbruvica (ibrutinib)
- 5.21.042 Marqibo (vincristine)
- 5.21.043 Treanda, Bendeka, Belrapzo, Vivimusta (bendamustine)
- 5.21.044 Cyramza (ramucirumab)
- 5.21.045 Velcade (bortezomib)
- 5.21.046 Zykadia (ceritinib)
- 5.21.047 Revlimid (lenalidomide)
- 5.21.048 Beleodaq (belinostat)
- 5.21.049 Zydelig (idelalisib)
- 5.21.050 Keytruda (pembrolizumab)
- 5.21.051 Blincyto (blinatumomab)
- 5.21.052 Lynparza (olaparib)
- 5.21.053 Opdivo (nivolumab)
- 5.21.054 Ibrance (palbociclib)
- 5.21.055 Lenvima (lenvatinib)
- 5.21.057 Romidepsin
- 5.21.058 Unituxin (dinutuximab)