| News & Announcements | Pharmaceutical Treatments of COVID-19 for AmeriHealth New Jersey Members (Updated May 4, 2021) | | | | | | 5/4/2021 | | | |
| News & Announcements | Pharmaceutical Treatments of COVID-19 for AmeriHealth Pennsylvania Members (Updated May 4, 2021) | | | | | | 5/4/2021 | | | |
| Notifications | Inebilizumab-cdon (Uplizna) | 08.01.68b | 5/11/2021 1:00 PM | 8/9/2021 | | | 5/11/2021 | Medical Necessity Criteria | | |
| New Policies | Melphalan flufenamide (Pepaxto®) | 08.01.78 | | 5/10/2021 | | | 5/10/2021 | This is a New Policy. | | |
| New Policies | Filgrastim (Neupogen ®) and related biosimilars, and tbo-filgrastim (Granix ®) | 08.01.73 | 12/31/2020 10:00 AM | 4/1/2021 | | | 5/13/2021 | This is a New Policy. | 5/13/2021 | |
| New Policies | Teprotumumab (Tepezza™) | 08.00.41 | 4/23/2021 9:00 AM | 5/24/2021 | | | 5/24/2021 | This is a New Policy. | | |
| New Policies | evinacumab-dgnb (Evkeeza) | 08.01.76 | | 5/24/2021 | | | 5/24/2021 | This is a New Policy. | | |
| Updated Policies | Botulinum Toxin Agents | 08.00.26x | | 5/3/2021 | | | 5/3/2021 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Contrast Agents Used in Conjunction with Echocardiography | 09.00.11e | 4/2/2021 2:00 PM | 5/3/2021 | | | 5/3/2021 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®) | 08.00.94o | | 5/10/2021 | | | 5/10/2021 | Medical Necessity Criteria | | |
| Updated Policies | Reimbursement for Associated Services Performed in Conjunction with Dental Care | 00.01.18e | | 5/10/2021 | | | 5/10/2021 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Fam-trastuzumab deruxtecan-nxki (Enhertu®) | 08.00.12b | | 5/24/2021 | | | 5/24/2021 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Isatuximab-irfc (Sarclisa®) | 08.00.46b | | 5/24/2021 | | | 5/24/2021 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Lurbinectedin (Zepzelca) | 08.01.67b | | 5/24/2021 | | | 5/24/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria | | |
| Updated Policies | Fecal Microbiota Transplantation (FMT) | 07.05.08b | | 5/31/2021 | | | 5/28/2021 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Reissue Policies | Hydroxyprogesterone Caproate Injection as a Technique to Reduce the Risk of Preterm Birth in High-Risk Pregnancies | 08.01.00g | | 10/1/2018 | 5/5/2021 | | 5/5/2021 | | | |
| Reissue Policies | crizanlizumab-tmca (Adakveo®) | 08.00.04 | | 11/30/2020 | 5/5/2021 | | 5/5/2021 | | | |
| Reissue Policies | Belantamab mafodotin-blmf (Blenrep) | 08.01.70b | | 4/1/2021 | 5/5/2021 | | 5/5/2021 | | | |
| Reissue Policies | Acupuncture (AmeriHealth) | 12.00.01f | | 1/1/2019 | 5/7/2021 | | 5/7/2021 | | | |
| Reissue Policies | Screening for Vertebral Fracture with Dual-Energy X-ray Absorptiometry (DEXA/DXA) | 09.00.40d | | 2/18/2016 | 5/5/2021 | | 5/7/2021 | | | |
| Reissue Policies | Positron Emission Mammography (PEM) | 09.00.51a | | 11/6/2013 | 5/5/2021 | | 5/7/2021 | | | |
| Reissue Policies | Moxetumomab Pasudotox-tdfk (Lumoxiti™) | 08.01.53b | | 10/1/2019 | 5/5/2021 | | 5/7/2021 | | | |
| Reissue Policies | Cerliponase alfa (Brineura®) | 08.01.39c | | 6/3/2019 | 5/5/2021 | | 5/10/2021 | | 5/10/2021 | |
| Reissue Policies | Emapalumab-lzsg (Gamifant®) | 08.01.54b | | 10/1/2019 | 5/5/2021 | | 5/10/2021 | | 5/10/2021 | |
| Reissue Policies | Composite Tissue Allotransplantation of the Hand(s) and Face | 11.14.30 | | 5/19/2017 | 5/18/2021 | | 5/19/2021 | | | |
| Reissue Policies | Pulse Oximetry Devices in the Home Setting | 05.00.31e | | 5/7/2018 | 5/19/2021 | | 5/21/2021 | | | |
| Reissue Policies | Compression Garments | 05.00.37f | | 5/6/2016 | 5/19/2021 | | 5/21/2021 | | | |
| Reissue Policies | Negative-Pressure Wound Therapy (NPWT) Systems | 05.00.38k | | 8/17/2020 | 5/19/2021 | | 5/21/2021 | | | |
| Reissue Policies | Composite Tissue Allotransplantation of the Hand(s) and Face | 11.14.30 | | 5/19/2017 | 5/19/2021 | | 5/21/2021 | | | |
| Reissue Policies | Percutaneous Intradiscal Annuloplasty (IDET/PIRFT) | 11.14.14e | | 7/1/2013 | 5/19/2021 | | 5/21/2021 | | | |
| Reissue Policies | Computer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | 11.14.17e | | 1/1/2021 | 5/19/2021 | | 5/21/2021 | | | |
| Reissue Policies | Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis | 11.15.22d | | 1/1/2017 | 5/19/2021 | | 5/21/2021 | | | |
| Reissue Policies | Non-Surgical Spinal Decompression Therapy | 07.08.01f | | 3/28/2016 | 5/19/2021 | | 5/21/2021 | | | |
| Reissue Policies | Speech and Non-Speech Generating Devices | 05.00.32j | | 7/5/2020 | 5/19/2021 | | 5/21/2021 | | | |
| Reissue Policies | Cryosurgical Ablation of the Prostate Gland | 11.11.03d | | 4/6/2015 | 5/19/2021 | | 5/24/2021 | | | |
| Reissue Policies | Mogamulizumab-kpkc (Poteligeo®) | 08.01.52c | | 1/18/2021 | 5/19/2021 | | 5/24/2021 | | | |
| Reissue Policies | Luspatercept–aamt (Reblozyl®) | 08.00.10b | | 7/1/2020 | 5/19/2021 | | 5/24/2021 | | | |
| Reissue Policies | Dofetilide (Tikosyn®) Use in the Inpatient Setting | 08.00.49e | | 9/26/2019 | 5/19/2021 | | 5/24/2021 | | | |
| Reissue Policies | Edaravone (Radicava®) | 08.01.42a | | 12/23/2018 | 5/19/2021 | | 5/24/2021 | | | |
| Reissue Policies | Ocrelizumab (Ocrevus®) | 08.01.38c | | 9/17/2019 | 5/19/2021 | | 5/24/2021 | | | |
| Reissue Policies | Sebelipase alfa (Kanuma®) | 08.01.28d | | 6/18/2020 | 5/19/2021 | | 5/24/2021 | | | |
| Reissue Policies | Tagraxofusp-erzs (Elzonris®) | 08.01.55c | | 6/4/2020 | 5/19/2021 | | 5/24/2021 | | | |
| Reissue Policies | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris®) | 08.00.84g | | 4/19/2020 | 5/19/2021 | | 5/24/2021 | | | |