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.
- 5.75.034 Viltepso (viltolarsen)
- 5.75.035 Amondys 45 (casimersen)
- 5.75.036 Ztalmy (ganaxolone)
- 5.75.037 Amvuttra (vutrisiran)
- 5.75.038 Relyvrio (sodium phenylbutyrate and taurursodiol) powder for suspension
- 5.75.039 Daybue (trofinetide)
- 5.75.040 Skyclarys (omaveloxolone)
- 5.75.041 Qalsody (tofersen)
- 5.75.042 Elevidys (delandistrogene moxeparvovec-rokl)
- 5.80.001 Medical Foods
- 5.85.001 Aranesp (darbepoetin alfa)
- 5.85.002 Berinert (C1 esterase inhibitor)
- 5.85.003 Ceprotin (protein C)
- 5.85.004 Cerezyme (imiglucerase)
- 5.85.005 Cinryze (C1 esterase inhibitor human)
- 5.85.006 Epoetin alfa
- 5.85.007 Kalbitor (ecallantide)
- 5.85.008 Leukine (sargramostim)
- 5.85.009 Neulasta Fulphila Fylnetra Nyvepria Stimufend Udenyca Ziextenzo
- 5.85.010 Neupogen Granix Nivestym Releuko Zarxio
- 5.85.011 Soliris (eculizumab)
- 5.85.012 VPRIV (velaglucerase alfa)
- 5.85.014 Elelyso (taliglucerase alfa)
- 5.85.015 Promacta (eltrombopag)
- 5.85.017 Ruconest (C1 esterase inhibitor recombinant)
- 5.85.018 Cerdelga (eliglustat)
- 5.85.019 Zavesca (miglustat)
- 5.85.020 Nplate (romiplostim)
- 5.85.021 Mircera (methoxy polyethylene glycol-epoetin beta)
- 5.85.023 Icatibant
- 5.85.025 Endari (L-glutamine)
- 5.85.026 Haegarda (C1 esterase inhibitor human)
- 5.85.027 Siklos (hydroxyurea)
- 5.85.029 Tavalisse (fostamatinib)
- 5.85.030 Doptelet (avatrombopag)
- 5.85.031 Mulpleta (lusutrombopag)
- 5.85.032 Takhzyro (lanadelumab-flyo)
- 5.85.033 Ultomiris (ravulizumab-cwvz)
- 5.85.034 Cablivi (caplacizumab-yhdp)
- 5.85.035 Reblozyl (luspatercept-aamt)
- 5.85.036 Adakveo (crizanlizumab-tmca)
- 5.85.037 Givlaari (givosiran)
- 5.85.038 Oxbryta (voxelotor)
- 5.85.039 Mozobil (plerixafor)
- 5.85.040 Orladeyo (berotralstat)
- 5.85.041 Nascobal (cyanocobalamin)
- 5.85.042 Empaveli (pegcetacoplan)
- 5.85.043 Tavneos (avacopan)
- 5.85.044 Rethymic (allogeneic processed thymus tissue-agdc)
- 5.85.045 Enjaymo (sutimlimab-jome)