This functionality is implemented using Javascript. It cannot work without it, etc...

Estamos cargando la información...

Saltar al contenido

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
M5.001.003 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 age,... 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 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 May 10, 2024 Feb 20, 2025 Primary hyperoxalurias are a group of rare genetic diseases. there are 3 subtypes each resulting in the... 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
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
P01.001.002 Beovu Jul 08, 2022 Jul 08, 2023 Beovu is covered under the medical benefit when used within the following guidelines. use outside of these... Ver
P1.001.001 Adakveo Sep 20, 2023 Sep 20, 2024 Adakveo may be considered medically necessary in patients 16 years of age or older with vasoocclusive crises... Ver
P1.001.004 Danyelza Sep 20, 2023 Sep 20, 2024 Initiation of danyelza meets the definition of medical necessity when used to treat the following indication... Ver
P1.001.005 Jemperli Sep 20, 2023 Sep 20, 2024 Jemperli may be considered medically necessary if the conditions below are... Ver

Últimos Artículos

Línea de atención Telexpreso

(787) 774-6060

TTY/TDD (787) 792-1370

Servicio al cliente Postal

(787) 474-5219

TTY/TDD 1-866-620-2520

Lunes a Viernes de 7:30 am a 8:00 pm (AST)
Sábados de 9:00 am a 6:00 pm (AST)
Domingos de 11:00 am a 5:00 pm (AST)

Línea de atención (libre de cargo)

1-800-981-3241

TTY/TDD 1-866-215-1999

Lunes a Viernes de 7:30 am a 8:00 pm (AST)
Sábados de 9:00 am a 6:00 pm (AST)
Domingos de 11:00 am a 5:00 pm (AST)

Centro de Llamadas de Servicios al Proveedor

1-877-357-9777

Lunes a Viernes de 7:30 am a 8:00 pm
Sábados de 8:00 am a 12:00 pm

Teléfono de Ventas

(787) 277-6644

Lunes a Viernes de 8:00 am a 4:30 pm (AST)

Administradores de Grupo y Productores

(787) 749-4519

Lunes a Viernes de 8:00 am a 5:00 pm (AST)

Teléfono de Ventas de Grupos

(787) 277-6664

Orientación Medicare Advantage

(787) 792-3508

Lunes a Viernes de 8:00 am a 6:00 pm (AST)

Planes Médicos

Triple-S Salud

Herramientas para ti

 

Ir arriba
787-277-6653 787-474-6326