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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
View requirements for Local Plan and BlueCard Out-of-Area members.
Medical Policies
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Pre-Determination of Medical Benefits Forms (A-E)
PW_B145637
Pre-determinations for Zometa and Neumega will not be required as previously announced. No review is required
Specialty pharmacy management program available online through AIM
®
Abraxane
®
Actemra
Adcetris
Advate Factor VIII
Aldurazyme
Alimta
®
Aralast
Aranesp
Avastin
Benlysta
®
Botulinum Toxin (Botox)
Campath
®
Ceredase/Cerezyme
Cimzia
Enbrel
Epogen/Procrit
Erbitux