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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 (F-N)

PW_B145640
 
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®
Fabrazyme
Flolan®, Remodulin
Growth Hormones
Halaven
Herceptin
Humira
Hyaluronan
Immune Globulin
Leukine/Prokine
Lumizyme Myozyme
Lupron
Naglazyme
Neulasta
Neupogen
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