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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
M5.001.018 Nucala® (mepolizumab) May 14, 2025 May 20, 2026 Mepolizumab is an interleukin-5 antagonist monoclonal antibody (igg1 kappa) for the add-on maintenance... Ver
M5.001.019 Fasenra® (benralizumab) May 14, 2025 May 20, 2026 Benralizumab is an interleukin-5 antagonist monoclonal antibody (igg1 kappa) for the add-on maintenance... Ver
M5.001.020 Givosiran for Acute Hepatic Porphyria May 14, 2025 May 20, 2026 Acute hepatic porphyria (ahp) is a rare disease with a prevalence of 5 to 10 cases/100,000 people in the us... Ver
M5.001.021 Biological Treatments for Refractory Myasthenia Gravis May 14, 2025 May 20, 2026 Myasthenia gravis is an autoimmune neuromuscular disorder characterized by fluctuating motor weakness... Ver
M5.001.022 Ultomiris® (ravulizumab-cwvz) May 14, 2025 May 20, 2025 Ravulizumab-cwvz is a complement inhibitor indicated as a treatment for adult patients, 18 years and older,... Ver
M5.001.023 Soliris (eculizumab) Aug 06, 2025 Aug 20, 2026 Soliris is a complement inhibitor indicated for the treatment of patients with paroxysmal nocturnal... Ver
M5.001.024 Adstiladrin® (nadofaragene firadenovec-vncg) Feb 20, 2025 Oct 20, 2025 Adstiladrin is a non-replicating adenoviral vector-based gene therapy indicated for the treatment of adult... Ver
M5.001.025 Mitotic Inhibitors Sep 25, 2025 Aug 20, 2026 Mitotic inhibitors (paclitaxel, docetaxel, abraxane) are chemotherapy agents used in multiple solid tumors,... Ver
M7.001.001 May 10, 2024 Policy Archived Studies have generally found that laser treatment can be effective at lightening port wine stains. the... Ver
MP.001.001 Dose rounding of drugs covered under the Medical Benefit Jul 08, 2025 May 20, 2026 ... Ver
MP.001.002 Leuprolide May 10, 2024 May 20, 2025 (leuprolide acetate) – a drug that is a manufactured version of a hormone. it is a hormone-releasing... Ver
MP.001.003 Split Surgical Package Jun 21, 2024 Jun 20, 2025 ... Ver
P01.001.001 Adakveo Jul 08, 2022 Jul 08, 2023 Adakveo is a prescription medicine used to treat the symptoms of sickle cell disease. adakveo may be used... Ver
P01.001.002 Beovu Jul 08, 2022 Jul 08, 2023 Beovu is a prescription medicine used to treat neovascular (wet) age-related macular degeneration (amd) and... Ver
P1.001.001 Adakveo Sep 17, 2024 Sep 20, 2025 Adakveo is a prescription medicine used to treat the symptoms of sickle cell disease. adakveo may be used... Ver
P1.001.004 Danyelza Sep 17, 2024 Sep 20, 2025 Danyelza (naxitamab-gqgk) is a gd2-binding monoclonal antibody indicated, in combination with... Ver
P1.001.005 Jemperli Sep 17, 2024 Sep 20, 2025 Jemperli is a programmed death receptor-1 (pd-1)–blocking antibody indicated for: endometrial cancer... Ver
P1.001.006 Margenza Sep 17, 2024 Sep 20, 2025 Margenza is a her2/neu receptor antagonist indicated, in combination with chemotherapy, for the treatment of... Ver
P1.001.007 Monjuvi Sep 17, 2024 Sep 20, 2025 Monjuvi is a cd19-directed cytolytic antibody indicated in combination with lenalidomide for the treatment of... Ver
P1.001.008 Rybrevant Sep 17, 2024 Sep 20, 2025 Rybrevant is a bispecific egf receptor-directed and met receptor-directed antibody indicated for the... Ver
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