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 | May 10, 2024 | Oct 20, 2024 | Viscosupplementation therapy is part of the therapy used in the treatment of osteoarthritis of the knee.... | Ver |
| M5.001.002 | Rituximab | May 10, 2024 | Oct 20, 2024 | Rituximab is a genetically engineered chimeric murine/human monoclonal igg1 kappa antibody directed against... | Ver |
| M5.001.003 | Trastuzumab – Trastuzumab Biologics | May 10, 2024 | 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 | Oct 26, 2023 | Retired | 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 | May 10, 2024 | 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 | May 10, 2024 | Oct 20, 2024 | White blood cell growth factors, also known as granulocyte colony stimulating factors (g-csf), are... | Ver |
| M5.001.007 | Somatuline® Depot; Lanreotide | May 10, 2024 | 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) | May 10, 2024 | 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) | May 10, 2024 | 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) | May 10, 2024 | Oct 20, 2024 | 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 | May 10, 2024 | 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]) | May 10, 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 | May 10, 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 | May 10, 2024 | Feb 20, 2025 | Hereditary transthyretin-mediated amyloidosis (hattr) is a rare, progressive, and fatal autosomal dominant... | Ver |
| M5.001.016 | Lumasiran for Primary Hyperoxaluria Type 1 | May 10, 2024 | Feb 20, 2025 | Primary hyperoxalurias are a group of rare genetic diseases. there are 3 subtypes each resulting in the... | Ver |
| M5.001.017 | Hemophilia Antihemophilic Factor | May 10, 2024 | Apr 20, 2025 | Criteria for the management of anti-hemophilic factors 1. the prescription must be written by a... | Ver |
| M5.001.018 | Nucala® (mepolizumab) | May 30, 2024 | May 20, 2025 | Coverage is provided in the following conditions: universal criteria ï‚· must not be used in... | Ver |
| M5.001.019 | Fasenra® (benralizumab) | May 30, 2024 | May 20, 2025 | Coverage is provided in the following conditions: universal criteria ï· must not be used in... | Ver |
| M5.001.020 | Givosiran for Acute Hepatic Porphyria | Jun 01, 2024 | Jun 20, 2025 | Initial treatment givosiran may be considered medically necessary if all of the following conditions are... | Ver |
