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.
- 5.21.213 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)
- 5.21.221 Anktiva (nogapendekin alfa inbakicept-pmln)
- 5.21.222 Ojemda (tovorafenib)
- 5.21.223 Imdelltra (tarlatamab-dlle)
- 5.22.001 Hemady (dexamethasone)
- 5.22.002 Tarpeyo (budesonide)
- 5.22.003 Xipere (triamcinolone acetonide injectable suspension)
- 5.22.004 Eohilia (budesonide) oral suspension
- 5.30.001 Naglazyme (galsulfase)
- 5.30.002 ART Drugs
- 5.30.004 Carbaglu (carglumic acid)
- 5.30.005 Egrifta SV (tesamorelin)
- 5.30.006 Tocolytics (terbutaline)
- 5.30.007 Increlex (mecasermin)
- 5.30.008 Elaprase (idursulfase)
- 5.30.009 Sandostatin LAR (octreotide acetate)
- 5.30.010 Acthar Gel
- 5.30.011 Growth Hormone – Adult Therapy
- 5.30.012 Growth Hormones Pediatric
- 5.30.013 Rayos (prednisone)
- 5.30.014 Sapropterin
- 5.30.015 Strensiq (asfotase alfa)
- 5.30.017 Prolia (denosumab)
- 5.30.018 Xgeva (denosumab)
- 5.30.019 SGLT2 Inhibitors
- 5.30.020 Metformin
- 5.30.021 Natpara (parathyroid hormone)
- 5.30.022 Serostim (somatropin)
- 5.30.023 Vimizim (elosulfase alfa)
- 5.30.024 Zorbtive (somatropin)
- 5.30.025 Korlym (mifepristone)
- 5.30.026 Signifor (pasireotide)
- 5.30.027 Somatuline Depot (lanreotide)
- 5.30.028 Afrezza (insulin human)
- 5.30.029 Ravicti (glycerol phenylbutyrate)
- 5.30.030 Buphenyl Olpruva Pheburane
- 5.30.031 Testosterone Topical
- 5.30.032 Testosterone Oral Buccal Nasal
- 5.30.033 Testosterone Injection and Implant
- 5.30.034 Lumizyme (alglucosidase alfa)
- 5.30.035 Fabrazyme (agalsidase beta)
- 5.30.036 Parathyroid Hormone Analogs
- 5.30.037 Testosterone Powder
- 5.30.038 Signifor LAR (pasireotide pamoate)