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.
- 5.85.057 Casgevy (exagamglogene autotemcel)
- 5.85.058 Lyfgenia (lovotibeglogene autotemcel)
- 5.85.059 Vafseo (vadadustat)
- 5.85.060 Voydeya (danicopan)
- 5.85.061 Xolremdi (mavorixafor)
- 5.85.062 Beqvez (fidanacogene elaparvovec-dzkt)
- 5.85.063 Lenmeldy (atidarsagene autotemcel)
- 5.85.064 Piasky (crovalimab-akkz)
- 5.85.065 Hympavzi (marstacimab-hncq)
- 5.85.066 Imaavy (nipocalimab-aahu)
- 5.85.068 Alhemo (concizumab-mtci)
- 5.85.069 Xromi (hydroxyurea)
- 5.90.001 Topical Rosacea Agents
- 5.90.002 Tazarotene
- 5.90.003 Tretinoin
- 5.90.004 Stelara (ustekinumab)
- 5.90.006 Regranex (becaplermin)
- 5.90.007 Lidocaine Patches
- 5.90.008 Zyclara (imiquimod)
- 5.90.009 Topical Antifungals
- 5.90.010 Luzu (luliconazole)
- 5.90.011 Cosentyx (secukinumab)
- 5.90.013 Oxistat (oxiconazole)
- 5.90.014 Exelderm (sulconazole nitrate)
- 5.90.015 Ertaczo (sertaconazole)
- 5.90.016 Solaraze (diclofenac sodium)
- 5.90.018 Taltz (ixekizumab)
- 5.90.020 Lidocaine Topicals
- 5.90.022 Cyclosporine Ophthalmics
- 5.90.023 Xiidra (lifeitegrast)
- 5.90.025 Eucrisa (crisaborole)
- 5.90.026 Ophthalmic VEGF Inhibitors
- 5.90.027 Doxepin Cream 5% (Prudoxin, Zonalon)
- 5.90.028 Siliq (brodalumab)
- 5.90.029 Lucentis (ranibizumab)
- 5.90.030 Dupixent (dupilumab)
- 5.90.031 Santyl (collagenase)
- 5.90.032 Tremfya (guselkumab)
- 5.90.033 Luxturna (voretigene neparvovec-rzyl)
- 5.90.034 Topical Products with Quantity Limits
- 5.90.035 Ilumya (tildrakizumab-asmn)
- 5.90.036 Oxervate (cenegermin-bkbj)
- 5.90.037 Qbrexza (glycopyrronium)
- 5.90.038 Skyrizi (risankizumab-rzaa)
- 5.90.039 Topical Corticosteroids
- 5.90.040 Topical Antifungals and Antibiotics
- 5.90.041 Antifungal and Antibiotic Powders
- 5.90.042 Qutenza (capsaicin patch)
- 5.90.043 Scenesse (afamelanotide)
- 5.90.044 Eysuvis (loteprednol etabonate)