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.
- 5.90.017 Oral Rinses
- 5.90.018 Taltz (ixekizumab)
- 5.90.019 Aldara (imiquimod)
- 5.90.020 Lidocaine Topicals
- 5.90.021 Aminolevulinic Acid
- 5.90.022 Cyclosporine Ophthalmics
- 5.90.023 Xiidra (lifeitegrast)
- 5.90.024 Topical Anti-Inflammatories
- 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)
- 5.90.045 Upneeq (oxymetazoline)
- 5.90.046 Klisyri (tirbanibulin)
- 5.90.047 Winlevi (clascoterone)
- 5.90.048 Isotretinoins
- 5.90.049 Aczone (dapsone)
- 5.90.050 Opzelura (ruxolitinib topical cream)
- 5.90.051 Tyrvaya (varenicline solution)
- 5.90.052 Susvimo (ranibizumab)
- 5.90.053 Adbry (tralokinumab-ldrm)
- 5.90.055 Cibinqo (abrocitinib)
- 5.90.056 Vtama (tapinarof) cream
- 5.90.057 Zoryve (roflumilast) cream
- 5.90.058 Hyftor
- 5.90.059 Sotyktu (deucravacitinib)
- 5.90.060 Spevigo (spesolimab-sbzo)
- 5.90.062 Syfovre (pegcetacoplan)
- 5.90.063 Vyjuvek (beremagene geperpavec-svdt)
- 5.90.064 Litfulo (ritlecitinib)
- 5.90.065 Izervay (avacincaptad pegol)
- 5.90.066 Xdemvy (lotilaner) ophthalmic solution
- 5.90.067 Bimzelx (bimekizumab-bkzx)
- 5.90.068 Omvoh (mirikizumab-mrkz)