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.
- 5.21.183 Tivdak (tisotumab vedotin-tftv)
- 5.21.184 Scemblix (asciminib)
- 5.21.185 Besremi (ropeginterferon alfa-2b-njft)
- 5.21.186 Fyarro (sirolimus protein-bound)
- 5.21.187 Kimmtrak (tebentafusp-tebn)
- 5.21.188 Carvykti (ciltacabtagene autoleucel)
- 5.21.189 Vonjo (pacritinib)
- 5.21.190 Opdualag (nivolumab and relatlimab-rmbw)
- 5.21.191 Pluvicto (lutetium Lu 177 vipivotide tetraxetan)
- 5.21.192 Vijoice (alpelisib)
- 5.21.193 Thalomid (thalidomide)
- 5.21.194 Lytgobi (futibatinib)
- 5.21.195 Imjudo (tremelimumab-actl)
- 5.21.196 Tecvayli (teclistamab-cqyv)
- 5.21.197 Elahere (mirvetuximab soravtansine-gynx)
- 5.21.198 Rezlidhia (olutasidenib)
- 5.21.199 Krazati (adagrasib)
- 5.21.200 Lunsumio (mosunetuzumab-axgb)
- 5.21.201 Jaypirca (pirtobrutinib)
- 5.21.202 Orserdu (elacestrant)
- 5.21.203 Zynyz (retifanlimab-dlwr)
- 5.21.204 Joenja (leniolisib)
- 5.21.205 Adstiladrin (nadofaragene firadenovec-vncg)
- 5.21.206 Epkinly (epcoritamab-bysp)
- 5.21.207 Columvi (glofitamab-gxbm)
- 5.21.208 Vanflyta (quizartinib)
- 5.21.209 Talvey (talquetamab-tgvs)
- 5.21.210 Elrexfio (elranatamab-bcmm)
- 5.21.211 Akeega (niraparib and abiraterone acetate)
- 5.21.212 Ojjaara (momelotinib)
- 5.21.213 Loqtorzi (toripalimab-tpzi)
- 5.21.214 Fruzaqla (fruquintinib)
- 5.21.215 Truqap (capivasertib)
- 5.21.216 Augtyro (repotrectinib)
- 5.21.217 Ogsiveo (nirogacestat)
- 5.21.218 Iwilfin (eflornithine)
- 5.21.219 Amtagvi (lifileucel)
- 5.21.220 Tevimbra (tislelizumab-jsgr)
- 5.21.221 Anktiva (nogapendekin alfa inbakicept-pmln)
- 5.21.222 Ojemda (tovorafenib)
- 5.21.223 Imdelltra (tarlatamab-dlle)
- 5.21.224 Rytelo (imetelstat)
- 5.21.225 Tecelra (afamitresgene autoleucel)
- 5.21.229 Lazcluze (lazertinib)
- 5.21.230 Itovebi (inavolisib)
- 5.21.231 Vyloy (zolbetuximab-clzb)
- 5.21.236 Aucatyzl (obecabtagene autoleucel)
- 5.21.237 Bizengri (zenocutuzumab-zbco)
- 5.22.001 Hemady (dexamethasone)
- 5.22.002 Tarpeyo (budesonide)