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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
M5.001.022 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 22, 2024 Aug 20, 2025 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
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 May 10, 2024 May 20, 2025 ... 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
P1.001.009 Elahere (mirvetuximab soravtansine-gynx) Sep 17, 2024 Sep 20, 2025 Elahere is a folate receptor alpha (frα)-directed antibody and microtubule inhibitor conjugate... Ver
P1.001.010 Ublituximab-xiiy (Briumvi) Oct 09, 2024 Sep 20, 2025 Ublituximab-xiiy is monoclonal antibody that is used to reduce the frequency of relapses and delay the... Ver
P1.001.011 Imjudo (tremelimumab-actl) injection Sep 17, 2024 Sep 20, 2025 Imjudo is a cytotoxic t-lymphocyte-associated antigen 4 (ctla-4) blocking antibody indicated: in combination... Ver
P1.001.012 Teclistamab (Tecvayli) Sep 17, 2024 Sep 20, 2025 Teclistamab (tecvayli) is a bispecific b-cell maturation antigen (bcma)-directed cd3 t-cell engaging antibody... Ver
P1.001.013 Enjaymo Sep 17, 2024 Sep 20, 2025 Sutimlimab-jome (enjaymo) is a monoclonal antibody that inhibits the classical complement pathway by binding... Ver
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