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Pre-Service Medical Benefit Review for Specialty Drugs

PW_A103227
Pre-determinations for Zometa and Neumega will not be required as previously announced. No review is required  
 
Abraxane® (effective 12/01/2009)  
Alimta® (effective 12/01/2009)  
Aloxi® (effective 12/01/2009)  
Amevive  
Avastin  
Botulinum Toxin  
Campath® (effective 12/01/2009)  
Ceredase/Cerezyme  
Eloxatin® (effective 12/01/2009)  
Enbrel  
Erbitux  
Faslodex® (effective 12/01/2009)  
Forteo  
Growth Hormones  
Herceptin 
Humira  
Hyaluronan  
Infertility  
IVIG_SQIG  
Lucentis  
Macugen  
Novantrone® (effective 12/01/2009)  
Orencia  
Prialt  
Proleukin® (effective 12/01/2009)  
Raptiva  
Red Cell Factors  
Remicade  
Remodulin  
Rituxan® (effective 12/01/2009)  
Synagis  
Tumor Necrosis Factor Antagonists  
Vectibix  
Velcade® (effective 12/01/2009)  
Vidaza® (effective 12/01/2009)  
White Cell Factors (updated September 1, 2009)  
Xolair  
© 2009 BlueCross BlueShield of Georgia
Blue Cross Blue Shield of Georgia and Blue Cross Blue Shield Healthcare Plan of Georgia are Independent licensees of the
Blue Cross Blue Shield Association.