Medical Policies
Policies that are included in the FEP Medical Policy Manual.
The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. They are not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. The Blue Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy, to recommend, advocate, encourage or discourage any particular medical technologies. Medical decisions relative to medical technologies are to be made strictly by members/patients in consultation with their health care providers. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that the Blue Cross and Blue Shield Service Benefit Plan covers (or pays for) this service or supply for a particular member.
- 5.60.046 Xywav (calcium, magnesium, potassium, sodium oxybates)
- 5.60.047 Kesimpta (ofatumumab)
- 5.60.048 Imcivree (setmelanotide)
- 5.60.049 Ponvory (ponesimod)
- 5.60.050 Qelbree (viloxazine)
- 5.60.051 Apomorphine
- 5.60.052 Aduhelm
- 5.60.053 Korsuva (difelikefalin)
- 5.60.054 Lybalvi (olanzapine and samidorphan)
- 5.60.055 Skysona (elivaldogene autotemcel)
- 5.60.056 Leqembi
- 5.60.057 Briumvi
- 5.60.058 Auvelity (dextromethorphan and bupropion)
- 5.60.059 Lumryz (sodium oxybate)
- 5.70.001 Abstral (fentanyl sublingual)
- 5.70.002 Actiq (transmucosal fentanyl)
- 5.70.003 5-HT1 Agonists (Triptans)
- 5.70.004 Arcalyst (rilonacept)
- 5.70.05 Axert (almotriptan)
- 5.70.006 Celebrex (celecoxib)
- 5.70.007 Fentora (fentanyl buccal)
- 5.70.08 Frova (frovatriptan)
- 5.70.009 Ilaris (canakinumab)
- 5.70.10 Sumatriptan
- 5.70.11 Sumatriptan Injection
- 5.70.012 Actemra (tocilizumab)
- 5.70.013 Ketalar (ketamine)
- 5.70.014 Krystexxa (pegloticase)
- 5.70.016 Maxalt (rizatriptan)
- 5.70.018 Orencia (abatacept)
- 5.70.19 Relpax (eletriptan)
- 5.70.021 Subsys (fentanyl sublingual spray)
- 5.70.22 Zomig (zolmitriptan)
- 5.70.023 Migraine Powders
- 5.70.024 Xeljanz (tofacitinib)
- 5.70.026 Anti-inflammatory Pain Powders
- 5.70.027 Enbrel (etanercept)
- 5.70.028 Ketamine Powder
- 5.70.029 Humira (adalimumab)
- 5.70.032 Suboxone Drug Class
- 5.70.037 Methotrexate Injections
- 5.70.041 Methadone
- 5.70.045 Sprix (ketorolac)
- 5.70.049 Anesthetic Powders
- 5.70.050 Kineret (anakinra)
- 5.70.051 Simponi / Simponi Aria
- 5.70.053 Otezla (apremilast)
- 5.70.054 Lidocaine injection
- 5.70.057 Fentanyl Powder
- 5.70.058 Butalbital Analgesics