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 |
|---|---|---|---|---|---|
| 05.001.015 | Advanced Therapies for Pharmacologic Treatment of Pulmonary Hypertension | Dec 20, 2023 | Dec 20, 2024 | Pulmonary arterial hypertension (pah) combination therapy for the treatment of pah (world health... | Ver |
| 05.001.016 | Uses of Monoclonal Antibodies for the Treatment of Non-Hodgkin Lymphoma | Nov 08, 2023 | Nov 20, 2024 | Intravenous rituximab intravenous rituximab (rituxan) may be considered medically necessary to treat... | Ver |
| 05.001.017 | Bevacizumab | Oct 26, 2023 | Oct 20, 2024 | The use of bevacizumab is considered medically necessary for the following conditions: i. fda-approved... | Ver |
| 05.001.019 | ABATACEPT (ORENCIA) | Oct 26, 2023 | Oct 20, 2024 | Abatacept is considered for payment in the following indications: adults with rheumatoid arthritis (ra)... | Ver |
| 05.001.021 | Vandetanib) – Oral Chemotheray | Oct 26, 2024 | Oct 20, 2024 | A. vandetanib is considered medically indicated in the treatment of metastatic or unresectable locally... | Ver |
| 05.001.023 | Newer Oral Anticoagulants | Jul 27, 2020 | Policy Archived | Nonvalvular atrial fibrillation rivaroxaban* (xarelto®), dabigatran* (pradaxa®), apixaban* (eliquis®),... | Ver |
| 05.001.024 | Ado-Trastuzumab Emtansine (Trastuzumab-DM1) for Treatment of HER2-Positive Malignancies | Aug 09, 2023 | Aug 20, 2024 | The use of ado-trastuzumab emtansine may be considered medically necessary in individuals with: human... | Ver |
| 05.001.026 | Pertuzumab for Treatment of Malignancies | Nov 08, 2023 | Nov 20, 2024 | In patients who have human epidermal growth factor receptor 2 (her2)-positive breast cancer, the use of... | Ver |
| 05.001.028 | Treatment for Spinal Muscular Atrophy | Apr 19, 2024 | Apr 20, 2025 | Nusinersen initial treatment nusinersen may be considered medically necessary if all the following... | Ver |
| 05.001.029 | Nononcologic Uses of Rituximab | Nov 09, 2023 | Nov 20, 2024 | Rituximab may be considered medically necessary for the following off-label indications:... | Ver |
| 05.001.030 | Testosterone Replacement Therapies | Aug 07, 2023 | Aug 20, 2024 | Testosterone replacement therapy may be considered medically necessary under the following conditions:... | Ver |
| 05.001.031 | Treatment for Duchenne Muscular Dystrophy | Jun 05, 2023 | Jun 20, 2024 | The use of antisense oligonucleotides (such as eteplirsen, golodirsen, viltolarsen,and casimersen) is... | Ver |
| 05.001.032 | Buprenorphine Implant for Treatment of Opioid Dependence | Oct 18, 2022 | Policy Archived | Buprenorphine subdermal implants may be considered medically necessary when all four of the following... | Ver |
| 05.001.033 | Treatment of Hereditary Transthyretin-Mediated Amyloidosis in Adult Patients | Apr 15, 2024 | Jan 20, 2025 | Initial treatment - hereditary transthyretin-mediated amyloidosis polyneuropathy patisiran, inotersen,... | Ver |
| 05.001.034 | Tropomyosin Receptor Kinase Inhibitors for Locally Advanced or Metastatic Solid Tumors Harboring an NTRK Gene Fusion | Apr 19, 2024 | Policy Archived | Larotrectinib and entrectinib are considered medically necessary when all of the following are met:... | Ver |
| 05.001.035 | Monoclonal Antibody Therapies for Migraine and Cluster Headache | Jan 08, 2024 | Jan 20, 2025 | Subcutaneously administered food and drug administration (fda)-approved monoclonal antibodies for calcitonin... | Ver |
| 05.001.036 | Brexanolone for Postpartum Depression | Sep 05, 2023 | Sep 20, 2024 | Individuals may be considered for a 1 time use of brexanolone per pregnancy if they meet all of the following... | Ver |
| 05.001.037 | Medical Cannabis for the Treatment of Pain and Spasticity | Sep 07, 2023 | Policy Archived | Inhaled cannabis or extracted cannabinoids are considered investigational for the treatment of the... | Ver |
| 05.001.038 | Erythropoiesis-Stimulating Agents | Nov 10, 2023 | Nov 20, 2024 | The use of epoetin alfa, darbepoetin, or pegylated epoetin beta may be considered medically necessary for:... | Ver |
| 05.001.039 | Intravenous Antibiotic Therapy and Associated Diagnostic Testing for Lyme Disease | Nov 15, 2023 | Nov 20, 2024 | Lyme disease treatment of lyme disease consists of oral antibiotics, except for the following indications.... | Ver |
