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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 |
|---|---|---|---|---|---|
| M5.001.009 | Stelara® (ustekinumab) | May 10, 2024 | May 20, 2025 | 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 | May 20, 2025 | 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 | May 20, 2025 | 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 Diseases | May 10, 2024 | May 20, 2025 | 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 | May 20, 2025 | C-1 esterase inhibitor protein is one of nine complement proteins found in the blood that works with the... | Ver |
| M5.001.014 | Immune Globulin | May 10, 2024 | May 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 | May 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 | May 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 | May 20, 2025 | The hemophilias are a group of related bleeding disorders that most commonly are inherited. inherited... | Ver |
| M5.001.018 | Nucala® (mepolizumab) | Jun 25, 2024 | Jun 20, 2025 | Coverage is provided in the following conditions: universal criteria ï· must not be used in... | Ver |
| M5.001.019 | Fasenra® (benralizumab) | Jun 25, 2024 | Jun 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 25, 2024 | Jun 20, 2025 | Initial treatment givosiran may be considered medically necessary if all of the following conditions are... | Ver |
| M5.001.021 | Biological Treatments for Refractory Myasthenia Gravis | Jun 25, 2024 | Jun 20, 2025 | Eculizumab and ravulizumab-cwvz - initial treatment eculizumab and ravulizumab-cwvz may be... | Ver |
| M5.001.022 | Ultomiris® (ravulizumab-cwvz) | Oct 09, 2024 | Jun 20, 2025 | Coverage is provided in the following conditions: • patient is at least 18 years of age (unless... | Ver |
| M5.001.023 | Soliris® (eculizumab) | Aug 22, 2024 | Aug 20, 2025 | Coverage is provided in the following conditions: • patient is at least 18 years of age (unless... | Ver |
| M7.001.001 | Laser Treatment of Wine Stains | May 10, 2024 | Policy Archived | Laser treatment of port wine stains in the presence of functional impairment related to the port wine stains... | Ver |
| MP.001.001 | Dose Rounding of Drug Covered Under The Medical Benefit | May 10, 2024 | May 20, 2025 | I. dose rounding for infused drug products to the nearest lowest vial size if within... | Ver |
| MP.001.002 | Leuprolide | May 10, 2024 | May 20, 2025 | Initial approval criteria a. prostate cancer (must meet all): 1. diagnosis of prostate cancer; 2.... | Ver |
| MP.001.003 | Split Surgical Package | Jun 21, 2024 | Jun 20, 2025 | This policy describes reimbursement for components of the global surgical package. the policy applies to... | Ver |
| P01.001.001 | Adakveo | Jul 08, 2022 | Jul 08, 2023 | Adakveo may be considered medically necessary in patients 16 years of age or older with vasoocclusive crises... | Ver |
