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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

View requirements for Local Plan and BlueCard Out-of-Area members.

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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
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