When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
Policy: 08.00.13x:Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
Policy: 08.00.15f:Off-label Coverage for Prescription Drugs and/or Biologics
Policy: 08.00.34n:Infliximab and Related Biosimilars
Policy: 08.00.62j:Abatacept (Orencia®) for Injection for Intravenous Use
Policy: 08.00.85i:Tocilizumab (Actemra®) for Intravenous Infusion
Policy: 08.01.15d:Golimumab (Simponi Aria®) Intravenous (IV) Injection
Policy: 08.00.08j:Radioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) (AmeriHealth Administrators)
On February 20, 2020, the following language was added to the Company-Designated Preferred Products section of the Policy section: Coverage of a biosimilar product as an alternate to a reference product is not considered a form of step therapy by the Company.