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Políticas Médicas

Las políticas médicas son documentos que definen el reconocimiento de cubierta para tecnologías, procedimientos y tratamientos. Las declaraciones de necesidad médica en las políticas, sobre si una tecnología, procedimiento, tratamiento, suplido, equipo, medicamento u otro servicio mejora el resultado en la salud de la población para la cual dicha tecnología o tratamiento fue diseñado se basan en evidencia científica, estudios clínicos y opiniones profesionales de nuestros proveedores y de las organizaciones médicas reconocidas.

Cada documento desplegado en este sitio Web se provee con propósitos informativos solamente y no es una autorización, explicación de beneficios o un contrato. El recibir beneficios está sujeto a la satisfacción de todos los términos y condiciones de la cubierta. La tecnología médica cambia constantemente y nos reservamos el derecho de revisar y actualizar nuestras políticas periódicamente.

ID Título Última Revisión Siguiente Revisión Descripción Acceso
M5.001.001 Viscosupplementation Therapy For Knee Oct 26, 2023 Oct 20, 2024 Viscosupplementation therapy is part of the therapy used in the treatment of osteoarthritis of the knee.... Ver
M5.001.002 Rituximab Oct 26, 2023 Oct 20, 2024 Rituximab is a genetically engineered chimeric murine/human monoclonal igg1 kappa antibody directed against... Ver
M5.001.003 Trastuzumab – Trastuzumab Biologics Oct 26, 2023 Oct 20, 2024 Trastuzumab is a monoclonal antibody, one of a group of drugs designed to attack specific cancer cells.... Ver
M5.001.004 Pegfilgrastim  Sep 20, 2023 Oct 26, 2023 Pegfilgrastim is a colony stimulating factor (csf) that acts on hematopoietic cells by binding to specific... Ver
M5.001.005 Bevacizumab – Bevacizumab Biologics for Oncologic Uses Oct 26, 2023 Oct 20, 2024 Bevacizumab is a humanized monoclonal antibody directed against vascular endothelial growth factor a... Ver
M5.001.006 CSF Hematopoietic Colony Stimulating Factors Oct 26, 2023 Oct 20, 2024 G-csf is classified as a recombinant hematopoietic stimulant. this is not a cancer chemotherapy agent. it is... Ver
M5.001.007 Somatuline® Depot; Lanreotide Dec 04, 2023 Dec 20, 2024 Somatuline® depot; lanreotide may be considered medically necessary in patients 18 years of age or older... Ver
M5.001.008 Simponi ARIA® (golimumab) Dec 04, 2023 Dec 20, 2024 Simponi aria® (golimumab) may be considered medically necessary in patients is at least 18 years of... Ver
M5.001.009 Stelara® (ustekinumab) Dec 04, 2023 Dec 20, 2024 Stelara® (ustekinumab) may be considered medically necessary if the following conditions are met: patient... Ver
M5.001.010 Infliximab (Remicade, Inflectra, Renflexis, Avsola and Unbranded Infliximab) Oct 13, 2023 Dec 20, 2023 Infliximab (remicade) is a tumor necrosis factor α (tnf-α) blocking agent approved by the u.s. food and... Ver
M5.001.011 Erythropoiesis Stimulating Agents Dec 04, 2023 Dec 20, 2024 Endogenous erythropoietin is a glycoprotein hematopoietic growth factor that regulates hemoglobin levels in... Ver
M5.001.012 Vascular Endothelial Growth Factor Inhibitors for the Treatment of Ophthalmological Deseases Dec 04, 2023 Dec 20, 2024 Vascular endothelial growth factor has been implicated in the pathogenesis of a variety of ocular vascular... Ver
M5.001.013 Ruconest (C1 Esterase Inhibitor [recombinant]) Feb 19, 2024 Feb 20, 2025 Coverage is provided in the following conditions: • patient is at least 13 years of age; and universal... Ver
M5.001.014 Immune Globulin Feb 15, 2024 Feb 20, 2025 Immune globulin (also referred to as gamma globulin or immunoglobulin) is a therapeutic compound prepared... Ver
M5.001.015 Treatment of Hereditary Transthyretin-Mediated Amyloidosis in Adult Patients Feb 15, 2024 Feb 20, 2025 Patisiran only it is given as intravenous infusion based on body weight. for individuals less than 100... Ver
M5.001.016 Lumasiran for Primary Hyperoxaluria Type 1 Feb 16, 2024 Feb 20, 2025 Primary hyperoxalurias are a group of rare genetic diseases. there are 3 subtypes each resulting in the... Ver
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