Must be used as initial treatment as a single agent with sequential chemoradiation
|
|
- Julie Hodges
- 6 years ago
- Views:
Transcription
1 Erbitux (cetuximab) Dcument Number: IC-0038 Last Review Date: 11/21/2017 Date f Origin: 12/22/2009 Dates Reviewed: 07/2010, 09/2010, 12/2010, 03/2011, 06/2011, 09/2011, 12/2011, 03/2012, 06/2012, 09/2012, 11/2012, 12/2012, 03/2013, 06/2013, 09/2013, 12/2013, 03/2014, 06/2014, 09/2014, 12/2014, 03/2015, 05/2015, 08/2015, 11/2015, 02/2016, 05/2016, 08/2016, 11/2016, 02/2017, 05/2017, 08/2017, 11/2017 I. Length f Authrizatin Cverage will be prvided fr six mnths and may be renewed. II. Dsing Limits A. Quantity Limit (max daily dse) [Pharmacy Benefit]: Erbitux 100 mg slutin fr injectin Erbitux 200 mg slutin fr injectin Weekly Every tw weeks 1 vial every 7 days 1 vial every 14 days 3 vials every 7 days (5 vials fr first dse nly) 6 vials every 14 days B. Max Units (per dse and ver time) [Medical Benefit]: Weekly Lad: 100 billable units x 1 dse Maintenance Dse: 60 billable units every 7 days Every tw weeks 120 billable units every 14 days III. Initial Apprval Criteria Cverage is prvided in the fllwing cnditins: Clrectal Cancer Patient is bth KRAS and NRAS mutatin negative (wild-type) as determined by FDAapprved tests; AND Patient has nt been previusly treated with cetuximab r panitumumab; AND Patient must have prgressive, metastatic, r unresectable advanced disease; AND Used in cmbinatin with irintecan- r xaliplatin-based regimens ; OR Used as a single agent therapy fr metastatic disease ; AND Patient has previusly failed n an xaliplatin- and irintecan-based regimen; OR Patient is unable t tlerate irintecan Mda Health Plan, Inc. Medical Necessity Criteria Page 1/9
2 Squamus Cell Carcinma f the Head and Neck (SCCHN) Used in ne f the fllwing regimens: In cmbinatin with radiatin therapy fr reginally r lcally advanced disease; OR As a single agent in recurrent r metastatic disease after failure n platinum-based therapy; OR In cmbinatin with platinum-based therapy fr first-line treatment f recurrent, lcreginal, r metastatic disease; AND Patient has ne f the fllwing types: Cancer f the Glttic Larynx Cancer f the Hyppharynx Cetuximab may als be used as a single agent fr sequential chemradiatin Cancer f the Lip Cancer f the Naspharynx Cancer f the Orpharynx Cetuximab may als be used as a single agent fr sequential chemradiatin Cancer f the Supraglttic Larynx Ethmid Sinus Tumrs Maxillary Sinus Tumrs Very advanced and recurrent/persistent head and neck cancer Cetuximab may als be used as a single agent fr very advanced and recurrent persistent head and neck cancer Occult Primary Head and Neck Cancers Must be used as initial treatment as a single agent with sequential chemradiatin Nn-melanma Skin Cancer (squamus cell cancers) Fr reginal recurrence r distant metastases Penile Cancer Patient must have metastatic disease; AND Must be used fr subsequent treatment; AND Must be used as a single agent Nn-Small Cell Lung Cancer (NSCLC) Patient must have metastatic disease; AND Must be used in cmbinatin with afatinib; AND Must be used as subsequent therapy fr sensitizing EGFR mutatin-psitive tumrs; AND Patient is T790M negative; AND Patient has prgressed n EGFR tyrsine kinase inhibitr therapy; AND Patient has multiple symptmatic systemic lesins FDA Apprved Indicatin(s); Cmpendia Recmmended Indicatin(s) Mda Health Plan, Inc. Medical Necessity Criteria Page 2/9
3 IV. Renewal Criteria Cverage can be renewed based upn the fllwing criteria: Patient cntinues t meet criteria identified in sectin III; AND Tumr respnse with stabilizatin f disease r decrease in size f tumr r tumr spread; AND Absence f unacceptable txicity frm the drug (e.g., severe infusin reactins, cardipulmnary arrest, pulmnary txicity/interstitial lung disease, dermatlgic txicity, electrlyte abnrmalities, etc.). V. Dsage/Administratin Indicatin Clrectal Cancer All ther indicatins Dse 400 mg/m² lading dse, then 250 mg/m² every 7 days; OR 500 mg/m² every 14 days 400 mg/m² lading dse, then 250 mg/m² every 7 days VI. Billing Cde/Availability Infrmatin Jcde: J9055 Injectin, cetuximab, 10 mg; 1 billable unit = 10 mg NDC: Erbitux 100 mg/50 ml single-use vial; slutin fr injectin: xx Erbitux 200 mg/100 ml single-use vial; slutin fr injectin: xx VII. References 1. Erbitux [package insert]. Branchburg, NJ; ImClne LLC; Octber 2016; Accessed September Referenced with permissin frm the NCCN Drugs & Bilgics Cmpendium (NCCN Cmpendium ) cetuximab. Natinal Cmprehensive Cancer Netwrk, The NCCN Cmpendium is a derivative wrk f the NCCN Guidelines. NATIONAL COMPREHENSIVE CANCER NETWORK, NCCN, and NCCN GUIDELINES are trademarks wned by the Natinal Cmprehensive Cancer Netwrk, Inc. T view the mst recent and cmplete versin f the Cmpendium, g nline t NCCN.rg. Accessed September Buchahda M, Macarulla G, Lled F, et al. Efficacy and safety f cetuximab (C) given with a simplified, every ther week (q2w), schedule in patients (pts) with advanced clrectal cancer (acrc): a multicenter, retrspective study. J Clin Oncl. 2008; 26(15S): Abstract Presented at: The 44th American Sciety f Clinical Onclgy Annual Meeting (ASCO). May 30 June 3, Chicag, Illinis. 4. Mrabti H, La Fuchardiere C, Desseigne F, Dussart S, Negrier S, Errihani H. Irintecan assciated with cetuximab given every 2 weeks versus cetuximab weekly in metastatic clrectal cancer. J Can Res Ther. 2009; 5: Mda Health Plan, Inc. Medical Necessity Criteria Page 3/9
4 5. Shitara K, Yuki S, Yshida M, et al. Phase II study f cmbinatin chemtherapy with biweekly cetuximab and irintecan fr wild-type KRAS metastatic clrectal cancer refractry t irintecan, xaliplatin, and flurpyrimidines Wrld J Gastrenterl, 2011, April 14; 17(14): Pfeiffer P, Bjerregarrd JK, Qvrtrup C, et al, Simplificatin f Cetuximab (Cet) Administratin: Duble Dse Every Secnd Week as a 60 Minute Infusin, J Clin Oncl, 2007, 25(18S):4133 [abstract 4133 frm 2007 ASCO Annual Meeting Prceedings, Part I]. 7. Pfeiffer P, Nielsen D, Bjerregaard J, et al, Biweekly Cetuximab and Irintecan as Third- Line Therapy in Patients with Advanced Clrectal Cancer after Failure t Irintecan, Oxaliplatin and 5-Flururacil, Ann Oncl, 2008, 19(6): Carneir BA, Ramanathan RK, Fakih MG, et al. Phase II study f irintecan and cetuximab given every 2 weeks as secnd-line therapy fr advanced clrectal cancer. Clin Clrectal Cancer Mar; 11(1): First Cast Service Optins, Inc. Lcal Cverage Determinatin (LCD): Cetuximab (Erbitux ) (L33278). Centers fr Medicare & Medicaid Services, Inc. Updated n 7/1/2014 with effective date 10/1/2015. Accessed September Palmett GBA. Lcal Cverage Determinatin (LCD): K-ras Testing Required befre Epidermal Grwth Factr Receptr Antibdy Use in Clrectal Cancer (L33434). Centers fr Medicare & Medicaid Services, Inc. Updated n 4/28/2017 with effective date 5/4/2017. Accessed September Cahaba Gvernment Benefit Administratrs, LLC. Lcal Cverage Article fr Drugs and Bilgicals - Chemtherapeutic Agents (A52701). Centers fr Medicare & Medicaid Services, Inc. Updated n 9/20/2017 with effective date 10/01/2017. Accessed September Appendix 1 Cvered Diagnsis Cdes ICD-10 ICD-10 Descriptin C00.0 Malignant neplasm f external upper lip C00.1 Malignant neplasm f external lwer lip C00.2 Malignant neplasm f external lip, unspecified C00.3 Malignant neplasm f upper lip, inner aspect C00.4 Malignant neplasm f lwer lip, inner aspect C00.5 Malignant neplasm f lip, unspecified, inner aspect C00.6 Malignant neplasm f cmmissure f lip, unspecified C00.8 Malignant neplasm f verlapping sites f lip C00.9 Malignant neplasm f lip, unspecified C01 Malignant neplasm f base f tngue C02.0 Malignant neplasm f drsal surface f tngue C02.1 Malignant neplasm f brder f tngue C02.2 Malignant neplasm f ventral surface f tngue C02.3 Malignant neplasm f anterir tw-thirds f tngue, part unspecified C02.4 Malignant neplasm f lingual tnsil C02.8 Malignant neplasm f verlapping sites f tngue Mda Health Plan, Inc. Medical Necessity Criteria Page 4/9
5 ICD-10 ICD-10 Descriptin C02.9 Malignant neplasm f tngue, unspecified C03.0 Malignant neplasm f upper gum C03.1 Malignant neplasm f lwer gum C03.9 Malignant neplasm f gum, unspecified C04.0 Malignant neplasm f anterir flr f muth C04.1 Malignant neplasm f lateral flr f muth C04.8 Malignant neplasm f verlapping sites f flr f muth C04.9 Malignant neplasm f flr f muth, unspecified C05.0 Malignant neplasm f hard palate C05.1 Malignant neplasm f sft palate C06.0 Malignant neplasm f cheek mucsa C06.2 Malignant neplasm f retrmlar area C06.80 Malignant neplasm f verlapping sites f unspecified parts f muth C06.89 Malignant neplasm f verlapping sites f ther parts f muth C06.9 Malignant neplasm f muth, unspecified C09.0 Malignant neplasm f tnsillar fssa C09.1 Malignant neplasm f tnsillar pillar (anterir) (psterir) C09.8 Malignant neplasm f verlapping sites f tnsil C09.9 Malignant neplasm f tnsil, unspecified C10.3 Malignant neplasm f psterir wall f rpharynx C11.0 Malignant neplasm f superir wall f naspharynx C11.1 Malignant neplasm f psterir wall f naspharynx C11.2 Malignant neplasm f lateral wall f naspharynx C11.3 Malignant neplasm f anterir wall f naspharynx C11.8 Malignant neplasm f verlapping sites f naspharynx C11.9 Malignant neplasm f naspharynx, unspecified C12 Malignant neplasm f pyrifrm sinus C13.0 Malignant neplasm f pstcricid regin C13.1 Malignant neplasm f aryepiglttic fid, hyppharyngeal aspect C13.2 Malignant neplasm f psterir wall f hyppharynx C13.8 Malignant neplasm f verlapping sites f hyppharynx C13.9 Malignant neplasm f hyppharynx, unspecified C14.0 Malignant neplasm f pharynx, unspecified C14.2 Malignant neplasm f Waldeyer's ring C14.8 Malignant neplasm f verlapping sites f lip, ral cavity and pharynx C17.0 Malignant neplasm dudenum C17.1 Malignant neplasm jejunum C17.2 Malignant neplasm ileum C17.8 Malignant neplasm f verlapping sites f small intestines Mda Health Plan, Inc. Medical Necessity Criteria Page 5/9
6 ICD-10 ICD-10 Descriptin C17.9 Malignant neplasm f small intestine, unspecified C18.0 Malignant neplasm f cecum C18.1 Malignant neplasm f appendix C18.2 Malignant neplasm f ascending cln C18.3 Malignant neplasm f hepatic flexure C18.4 Malignant neplasm f transverse cln C18.5 Malignant neplasm f splenic flexure C18.6 Malignant neplasm f descending cln C18.7 Malignant neplasm f sigmid cln C18.8 Malignant neplasm f verlapping sites f large intestines C18.9 Malignant neplasm f cln, unspecified C19 Malignant neplasm f rectsigmid junctin C20 Malignant neplasm f rectum C21.8 Malignant neplasm f verlapping sites f rectum, anus and anal canal C30.0 Malignant neplasm f nasal cavity C31.0 Malignant neplasm f maxillary sinus C31.1 Malignant neplasm f ethmidal sinus C32.0 Malignant neplasm f glttis C32.1 Malignant neplasm f supraglttis C32.2 Malignant neplasm f subglttis C32.3 Malignant neplasm f laryngeal cartilage C32.8 Malignant neplasm f verlapping sites f larynx C32.9 Malignant neplasm f larynx, unspecified C33 Malignant neplasm f trachea C34.00 Malignant neplasm f unspecified main brnchus C34.01 Malignant neplasm f right main brnchus C34.02 Malignant neplasm f left main brnchus C34.10 Malignant neplasm f upper lbe, unspecified brnchus r lung C34.11 Malignant neplasm f upper lbe, right brnchus r lung C34.12 Malignant neplasm f upper lbe, left brnchus r lung C34.2 Malignant neplasm f middle lbe, brnchus r lung C34.30 Malignant neplasm f lwer lbe, unspecified brnchus r lung C34.31 Malignant neplasm f lwer lbe, right brnchus r lung C34.32 Malignant neplasm f lwer lbe, left brnchus r lung C34.80 Malignant neplasm f verlapping sites f unspecified brnchus and lung C34.81 Malignant neplasm f verlapping sites f right brnchus and lung C34.82 Malignant neplasm f verlapping sites f left brnchus and lung C34.90 Malignant neplasm f unspecified part f unspecified brnchus r lung C34.91 Malignant neplasm f unspecified part f right brnchus r lung Mda Health Plan, Inc. Medical Necessity Criteria Page 6/9
7 ICD-10 ICD-10 Descriptin C34.92 Malignant neplasm f unspecified part f left brnchus r lung C44.00 Unspecified malignant neplasm f skin f lip C44.02 Squamus cell carcinma f skin f lip C44.09 Other specified malignant neplasm f skin f lip C Squamus cell carcinma f skin f unspecified eyelid, including canthus C Squamus cell carcinma f skin f right eyelid, including canthus C Squamus cell carcinma f skin f left eyelid, including canthus C Squamus cell carcinma f skin f unspecified ear and external auricular canal C Squamus cell carcinma f skin f right ear and external auricular canal C Squamus cell carcinma f skin f left ear and external auricular canal C Squamus cell carcinma f skin f unspecified parts f face C Squamus cell carcinma f skin f nse C Squamus cell carcinma f skin f ther parts f face C44.42 Squamus cell carcinma f skin f scalp and neck C Squamus cell carcinma f anal skin C Squamus cell carcinma f skin f breast C Squamus cell carcinma f skin f ther part f trunk C Squamus cell carcinma f skin f unspecified upper limb, including shulder C Squamus cell carcinma f skin f right upper limb, including shulder C Squamus cell carcinma f skin f left upper limb, including shulder C Squamus cell carcinma f skin f unspecified lwer limb, including hip C Squamus cell carcinma f skin f right lwer limb, including hip C Squamus cell carcinma f skin f left lwer limb, including hip C44.82 Squamus cell carcinma f verlapping sites f skin C44.92 Squamus cell carcinma f skin, unspecified C60.0 Malignant neplasm f prepuce C60.1 Malignant neplasm f glans penis C60.2 Malignant neplasm f bdy f penis C60.8 Malignant neplasm f verlapping sites f penis C60.9 Malignant neplasm f penis, unspecified C63.7 Malignant neplasm f ther specified male genital rgans C63.8 Malignant neplasm f verlapping sites f male genital rgans C76.0 Malignant neplasm f head, face and neck C77.0 Secndary and unspecified malignant neplasm f lymph ndes f head, face and neck C78.00 Secndary malignant neplasm f unspecified lung C78.01 Secndary malignant neplasm f right lung C78.02 Secndary malignant neplasm f left lung C78.6 Secndary malignant neplasm f retrperitneum and peritneum C78.7 Secndary malignant neplasm f liver and intrahepatic bile duct Mda Health Plan, Inc. Medical Necessity Criteria Page 7/9
8 ICD-10 ICD-10 Descriptin C78.89 Secndary malignant neplasm f ther digestive rgans D37.01 Neplasm f uncertain behavir f lip D37.02 Neplasm f uncertain behavir f tngue D37.05 Neplasm f uncertain behavir f pharynx D37.09 Neplasm f uncertain behavir f ther specified sites f the ral cavity D38.0 Neplasm f uncertain behavir f larynx D38.5 Neplasm f uncertain behavir f ther respiratry rgans D38.6 Neplasm f uncertain behavir f respiratry rgan, unspecified Z Persnal histry f ther malignant neplasm f large intestine Z Persnal histry f ther malignant neplasm f brnchus and lung Z85.21 Persnal histry f malignant neplasm f larynx Z85.22 Persnal histry f malignant neplasm f nasal cavities, middle ear, and accessry sinuses Z Persnal histry f malignant neplasm f tngue Z Persnal histry f malignant neplasm f ther sites f lip, ral cavity and pharynx Z Persnal histry f malignant neplasm f unspecified site f lip, ral cavity and pharynx Z Persnal histry f ther malignant neplasm f skin Appendix 2 Centers fr Medicare and Medicaid Services (CMS) Medicare cverage fr utpatient (Part B) drugs is utlined in the Medicare Benefit Plicy Manual (Pub ), Chapter 15, 50 Drugs and Bilgicals. In additin, Natinal Cverage Determinatin (NCD) and Lcal Cverage Determinatins (LCDs) may exist and cmpliance with these plicies is required where applicable. They can be fund at: Additinal indicatins may be cvered at the discretin f the health plan. Medicare Part B Cvered Diagnsis Cdes (applicable t existing NCD/LCD): Jurisdictin(s): N NCD/LCD Dcument (s): L33278 Jurisdictin(s): M NCD/LCD Dcument (s): L33434 Jurisdictin(s): J NCD/LCD Dcument (s): A Medicare Part B Administrative Cntractr (MAC) Jurisdictins Jurisdictin Applicable State/US Territry Cntractr E (1) CA, HI, NV, AS, GU, CNMI Nridian Healthcare Slutins, LLC Mda Health Plan, Inc. Medical Necessity Criteria Page 8/9
9 Medicare Part B Administrative Cntractr (MAC) Jurisdictins Jurisdictin Applicable State/US Territry Cntractr F (2 & 3) AK, WA, OR, ID, ND, SD, MT, WY, UT, AZ Nridian Healthcare Slutins, LLC 5 KS, NE, IA, MO Wiscnsin Physicians Service Insurance Crp (WPS) 6 MN, WI, IL Natinal Gvernment Services, Inc. (NGS) H (4 & 7) LA, AR, MS, TX, OK, CO, NM Nvitas Slutins, Inc. 8 MI, IN Wiscnsin Physicians Service Insurance Crp (WPS) N (9) FL, PR, VI First Cast Service Optins, Inc. J (10) TN, GA, AL Cahaba Gvernment Benefit Administratrs, LLC M (11) NC, SC, WV, VA (excluding belw) Palmett GBA, LLC L (12) DE, MD, PA, NJ, DC (includes Arlingtn & Fairfax cunties and the city f Alexandria in VA) Nvitas Slutins, Inc. K (13 & 14) NY, CT, MA, RI, VT, ME, NH Natinal Gvernment Services, Inc. (NGS) 15 KY, OH CGS Administratrs, LLC Mda Health Plan, Inc. Medical Necessity Criteria Page 9/9
Kadcyla (ado-trastuzumab emtansine) Document Number: IC-0092
Kadcyla (ad-trastuzumab emtansine) Dcument Number: IC-0092 Last Review Date: 2/6/2018 Date f Origin: 05/16/2013 Dates Reviewed: 7/2013, 11/2013, 12/2013, 3/2014, 6/2014, 9/2014, 12/2014, 5/2015, 8/2015,
More informationPerjeta (pertuzumab) Document Number: IC I. Length of Authorization. Dosing Limits. Initial Approval Criteria
Perjeta (pertuzumab) Last Review Date: 11/21/2017 Date f Origin: 11/01/2012 Dcument Number: IC-0096 Dates Reviewed: 12/2012, 3/2013, 6/2013, 9/2013, 11/2013, 12/2013, 3/2014, 6/2014, 9/2014, 12/2014, 3/2015,
More informationMylotarg (gemtuzumab ozogamicin) (Intravenous)
Myltarg (gemtuzumab zgamicin) (Intravenus) Last Review Date: 09/19/2017 Date f Origin: 09/19/2017 Dates Reviewed: 09/2017 Dcument Number: IC-0320 I. Length f Authrizatin Newly-Diagnsed AML De nv disease
More informationAbraxane (paclitaxel protein-bound particles) (Intravenous)
Abraxane (paclitaxel prtein-bund particles) (Intravenus) Last Review Date: 5/30/2017 Date f Origin: 10/17/2008 Dcument Number: IC-0001 Dates Reviewed: 06/2009, 12/2009, 07/2010, 09/2010, 12/2010, 03/2011,
More informationSandostatin LAR (octreotide suspension) Document Number: IC-0111
Sandstatin LAR (ctretide suspensin) Dcument Number: IC-0111 Last Review Date: 02/06/2018 Date f Origin: 06/21/2011 Dates Reviewed: 09/2011, 12/2011, 03/2012, 06/2012, 09/2012, 12/2012, 03/2013, 06/2013,
More informationOpdivo (nivolumab) (Intravenous)
Opdiv (nivlumab) (Intravenus) Last Review Date: 1/03/2018 Date f Origin: 01/06/2015 Dcument Number: IC-0226 Dates Reviewed: 03/2015, 07/2015, 10/2015, 11/2015, 02/2016, 05/2016, 08/2016, 10/2016, 11/2016,
More informationYescarta (axicabtagene ciloleucel) (Intravenous)
Yescarta (axicabtagene cilleucel) (Intravenus) Last Review Date: 10/31/2017 Date f Origin: 10/31/2017 Dates Reviewed: 10/2017 Dcument Number: IC-0333 I. Length f Authrizatin Cverage will be prvided fr
More informationCyramza (ramucirumab) (Intravenous)
Cyramza (ramucirumab) (Intravenous) Document Number: IC 0199 Last Review Date: 5/1/2018 Date of Origin: 06/24/2014 Dates Reviewed: 09/2014, 01/2015, 05/2015, 11/2015, 04/2016, 08/2016, 11/2016, 05/2017,
More informationTecentriq (atezolizumab) (Intravenous)
Tecentriq (atezolizumab) (Intravenous) Last Review Date: 06/01/2018 Date of Origin: 06/28/2016 Document Number: IC-0278 Dates Reviewed: 06/2016, 08/2016, 10/2016, 02/2017, 04/2017, 08/2017, 11/2017, 02/2018,
More informationImfinzi (durvalumab) (Intravenous)
Imfinzi (durvalumab) (Intravenous) Last Review Date: 09/05/2018 Date of Origin: 05/30/2017 Dates Reviewed: 05/2017, 08/2017, 11/2017, 02/2018, 05/2018, 09/2018 Document Number: IC-0301 I. Length of Authorization
More informationVelcade (bortezomib) Document Number: IC-0137
Velcade (bortezomib) Document Number: IC-0137 Last Review Date: 11/21/2017 Date of Origin: 11/28/2011 Dates Reviewed: 12/2011, 03/2012, 06/2012, 09/2012, 12/2012, 03/2013, 06/2013, 09/2013, 12/2013, 03/2014,
More informationDates Reviewed: 12/2012, 3/2013, 6/2013, 9/2013, 11/2013, 12/2013, 3/2014, 6/2014, 9/2014, 12/2014,
Perjeta (pertuzumab) Last Review Date: 5/30/2017 Date of Origin: 11/01/2012 Document Number: IC-0096 Dates Reviewed: 12/2012, 3/2013, 6/2013, 9/2013, 11/2013, 12/2013, 3/2014, 6/2014, 9/2014, 12/2014,
More informationKrystexxa (pegloticase) Document Number: IC-0158
Krystexxa (pegloticase) Document Number: IC-0158 Last Review Date: 06/27/2017 Date of Origin: 02/07/20103 Dates Reviewed: 11/2013, 08/2014, 07/2015, 07/2016, 09/2016, 12/2016, 03/2017, 06/2017 I. Length
More informationEylea (aflibercept) Document Number: IC-0026
Eylea (aflibercept) Document Number: IC-0026 Last Review Date: 3/1/2018 Date of Origin: 02/07/2013 Dates Reviewed: 03/07/2013, 06/2013, 09/2013, 12/2013, 03/2014, 06/2014, 09/2014, 12/2014, 03/2015, 04/2015,
More informationPatient must be 18 years of age or older (unless otherwise specified); AND
(Intravenus) Last Review Date: January 1, 2019 Number: MG.MM.PH.89 Medical Guideline Disclaimer C All rights reserved. The treating physician r primary care prvider must submit t EmblemHealth the clinical
More informationSoliris (eculizumab) Document Number: MODA-0114
Sliris (eculizumab) Dcument Number: MODA-0114 Last Review Date: 9/19/2017 Date f Origin: 06/21/2011 Dates Reviewed: 09/2011, 12/2011, 03/2012, 06/2012, 09/2012, 12/2012, 03/2013, 03/2014, 06/2014, 09/2014,
More informationRituxan Hycela (rituximab and hyaluronidase human) (Subcutaneous)
Rituxan Hycela (rituximab and hyaluronidase human) (Subcutaneous) Document Number: IC-0322 Last Review Date: 02/06/2018 Date of Origin: 7/20/2010 Dates Reviewed: 09/2010, 12/2010, 02/2011, 03/2011, 05/2011,
More informationIntravitreal Avastin (Bevacizumab)
Intravitreal Avastin (Bevacizumab) Date of Origin: 10/18/2018 Last Review Date: 10/18/2018 Effective Date: 10/18/2018 Dates Reviewed: 10/2018 Developed By: Medical Criteria Committee I. Length of Authorization
More informationOrencia (abatacept) Document Number: MODA-0091
Orencia (abatacept) Dcument Number: MODA-0091 Last Review Date: 09/19/2017 Date f Origin: 07/02/2010 Dates Reviewed: 07/2010, 09/2010, 12/2010, 02/15/11, 03/2011, 06/2011, 09/2011, 12/2011, 03/2012, 06/2012,
More informationYervoy (ipilmumab) Last Review Date: 03/25/2014 Date of Origin: 11/28/2011. Prior Auth Available: Post-Service Edit:
Yervoy (ipilmumab) Date of Origin: 11/28/2011 Prior Auth Available: Post-Service Edit: Dates Reviewed: 12/13/2011, 03/2012, 06/19/2012, 09/06/2012, 12/06/2012, 05/16/2013, 06/06/2013, 09/05/2013, 12/05/2013,
More informationDocument Number: IC I. Length of Authorization. Dosing Limits
Hyaluronic Acid Derivatives: Durolane, Euflexxa, Gel-One, GelSyn-3, GenVisc 850, Hyalgan, Hymovis, Monovisc, Orthovisc, Supartz/Supartz FX, Synojoynt, Synvisc, & Synvisc-One, TriVisc, Visco-3 (Intra-articular)
More informationErythropoiesis Stimulating Agents (ESAs): Aranesp (darbepoetin alfa) Related Medical Guideline Off-Label Use of FDA-Approved Drugs and Biologicals
(Subcutaneus/Intravenus) Last Review Date: January 1, 2019 Number: MG.MM.PH.80 *NON-DIALYSIS* Medical Guideline Disclaimer C All rights reserved. The treating physician r primary care prvider must submit
More informationActemra (tocilizumab) (Intravenous)
Actemra (tcilizumab) (Intravenus) Last Review Date: 06/01/2018 Date f Origin: 09/21/2010 Dcument Number: MODA-0002 Dates Reviewed: 12/2010, 03/2011, 05/2011, 06/2011, 09/2011, 12/2011, 03/2012, 06/2012,
More informationFolotyn (pralatrexate)
Fltyn (pralatrexate) Line(s) f Business: HMO; PPO; QUEST Integratin Akamai Advantage Original Effective Date: 10/01/2015 Current Effective Date: 01/01/2018TBD03/01/2017 POLICY A. INDICATIONS The indicatins
More informationAlimta (pemetrexed) Document Number: IC 0007
Alimta (pemetrexed) Document Number: IC 0007 Last Review Date: 05/01/2018 Date of Origin: 07/20/2010 Dates Reviewed: 09/2010, 12/2010, 03/2011, 06/2011,0 9/2011, 12/2011, 03/2012, 06/2012, 09/2012, 12/2012,
More informationXX Abraxane 100 MG SUSR (CELGENE CORP)
Plicy Medical Plicy Manual Apprved: D Nt Implement Until 1/31/19 Paclitaxel (Prtein-Bund) NDC CODE(S) 68817-0134-XX Abraxane 100 MG SUSR (CELGENE CORP) DESCRIPTION Paclitaxel is a natural prduct with antitumr
More informationTrelstar (triptorelin) (Intramuscular)
Trelstar (triptorelin) (Intramuscular) Last Review Date: 02/06/2018 Date of Origin: 11/28/2011 Document Number: IC-0131 Dates Reviewed: 12/2011, 03/2012, 06/19/2012, 09/2012, 12/2012, 03/2013, 06/2013,
More informationXX Abraxane 100 MG SUSR (CELGENE CORP
Medical Manual Apprved Revised: D Nt Implement until 6/30/2019 Paclitaxel (Prtein-Bund) NDC CODE(S) 68817-0134-XX Abraxane 100 MG SUSR (CELGENE CORP DESCRIPTION Paclitaxel is a natural prduct with antitumr
More informationColony Stimulating Factors: Zarxio (filgrastim sndz) (Subcutaneous/Intravenous)
Colony Stimulating Factors: Zarxio (filgrastim sndz) (Subcutaneous/Intravenous) Document Number: IC 0245 Last Review Date: 5/1/2018 Date of Origin: 03/31/2015 Dates Reviewed: 03/2015, 05/2015, 08/2015,
More informationTrelstar Depot (triptorelin)
Dates Reviewed: 12/13/2011, 03/2012, 06/19/2012, 09/06/2012, 12/06/2012, 03/07/2013, 06/06/2013, Date of Origin: 11/28/2011 09/05/2013, 12/05/2013, 03/25/2014 Prior Auth Available: Post-service edit: The
More informationSCIG: Hizentra, Gammagard Liquid, Gamunex -C, Gammaked, Hyqvia, Cuvitru (immune globulin SQ)
SCIG: Hizentra, Gammagard Liquid, Gamunex -C, Gammaked, Hyqvia, Cuvitru (immune glbulin SQ) Dcument Number: IC-0059 Last Review Date: 04/03/2018 Date f Origin: 7/20/2010 Dates Reviewed: 9/2010, 12/2010,
More informationXX Keytruda 100 MG/4ML SOLN (MERCK SHARP & DOHME)
Plicy Medical Plicy Manual Apprved: D Nt Implement Until 1/31/19 Pembrlizumab NDC CODE(S) 00006-3026-XX Keytruda 100 MG/4ML SOLN (MERCK SHARP & DOHME) DESCRIPTION Pembrlizumab is a human prgrammed death
More informationSoliris (eculizumab) (Intravenous)
Sliris (eculizumab) (Intravenus) Last Review Date: 02/04/2019 Date f Origin: 06/21/2011 Dcument Number: MODA-0114 Dates Reviewed: 09/2011, 12/2011, 03/2012, 06/2012, 09/2012, 12/2012, 03/2013, 03/2014,
More informationRituxan (rituximab) Effective Date: 10/01/2015. Line(s) of Business: HMO; PPO; QUEST Integration Akamai Advantage
Rituxan (rituximab) Line(s) f Business: HMO; PPO; QUEST Integratin Akamai Advantage Effective Date: 10/01/2015 POLICY A. INDICATIONS The indicatins belw including FDA-apprved indicatins and cmpendial uses
More informationIlaris (canakinumab) (Subcutaneous)
Ilaris (canakinumab) (Subcutaneous) Last Review Date: 08/02/2018 Date of Origin: 11/07/2013 Dates Reviewed: 08/2014, 07/2015, 07/2016, 10/2016, 10/2017, 08/2018 Document Number: IC-0177 I. Length of Authorization
More informationProlia /Xgeva (denosumab) Document Number: IC-0098
/ (denosumab) Document Number: IC-0098 Last Review Date: 5/30/2017 Date of Origin: 11/28/2011 Dates Reviewed: 12/2011, 03/2012, 06/2012, 09/2012, 12/2012, 03/2013, 06/2013, 03/2014, 06/2014, 09/2014, 12/2014,
More informationFederation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Retaking NPTE
The table below lists the requirements for retaking the National Physical Therapy Exam (NPTE) for each jurisdiction. Summary Number of attempts on NPTE limited? 16 27 Number of attempts allowed before
More informationColony Stimulating Factors: Nivestym (filgrastim-aafi) (Subcutaneous/Intravenous)
Colony Stimulating Factors: Nivestym (filgrastim-aafi) (Subcutaneous/Intravenous) Document Number: MODA-0375 Last Review Date: 08/06/2018 Date of Origin: 08/06/2018 Dates Reviewed: 08/2018 I. Length of
More informationRituxan (rituximab) Document Number: IC-0109
Rituxan (rituximab) Dcument Number: IC-0109 Last Review Date: 10/31/2017 Date f Origin: 7/20/2010 Dates Reviewed: 09/2010, 12/2010, 02/2011, 03/2011, 05/2011, 06/2011, 09/2011, 12/2011, 03/2012, 06/2012,
More informationErythropoiesis Stimulating Agents (ESAs): Epogen/Procrit (epoetin alfa) (Subcutaneous/Intravenous)
(Subcutaneus/Intravenus) Last Review Date: January 1, 2019 Number: MG.MM.PH.81 Medical Guideline Disclaimer C All rights reserved. The treating physician r primary care prvider must submit t EmblemHealth
More informationAll indications: 60 billable units every 6 months. Giant Cell Tumor of Bone; Hypercalcemia of malignancy
Last Review Date: January 1, 2019 Number: MG.MM.PH.100 Medical Guideline Disclaimer C All rights reserved. The treating physician r primary care prvider must submit t EmblemHealth the clinical evidence
More informationErythropoiesis Stimulating Agents (ESAs): Aranesp (darbepoetin alfa) (Subcutaneous/Intravenous) *NON DIALYSIS* Document Number: IC 0242
Erythropoiesis Stimulating Agents (ESAs): Aranesp (darbepoetin alfa) (Subcutaneous/Intravenous) *NON DIALYSIS* Document Number: IC 0242 Last Review Date: 05/01/2018 Date of Origin: 10/17/2008 Dates Reviewed:
More informationFederation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Direct Access
Each licensing authority indicates the level of direct access allowed in the jurisdiction and the type of limitations that apply to this access. There are two tables: Types and Limits Referrals TYPES AND
More informationo Prostanoids/prostacyclin therapies (oral and inhaled) o Inhaled agents: Ventavis, Tyvaso Page 1 of 5 Revised 02/17/17
Request fr Prir Authrizatin Pulmnary Arterial Hypertensin (PAH) Agents (Oral and Inhaled) Website Frm www.highmarkhealthptins.cm Submit request via: Fax - 1-855-476-4158 All requests fr Pulmnary Arterial
More informationFinancial Impact of Lung Cancer in West Virginia
Financial Impact of Lung Cancer in West Virginia John Deskins, Ph.D. Christiadi, Ph.D. Sara Harper November 2018 Bureau of Business & Economic Research College of Business & Economics West Virginia University
More informationFederation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Direct Access
Each licensing authority indicates the level of direct access allowed in the jurisdiction and the type of limitations that apply to this access. There are two tables: Types and Limits Referrals TYPES AND
More informationDrug Therapy Guidelines
Applicable Medical Benefit x Effective: 5/1/18 Pharmacy- Frmulary 1 x Next Review: 3/18 Pharmacy- Frmulary 2 x Date f Origin: 4/99 Gnadtrpin-Releasing Hrmne Agnists- Eligard, Luprn, Luprn-Dept, Luprn Dept-Ped,
More informationCardiac Rehabilitation Services
Dcumentatin Guidance N. DG1011 Cardiac Rehabilitatin Services Revisin Letter A 1.0 Purpse The Centers fr Medicare and Medicaid Services (CMS) has detailed specific dcumentatin requirements fr Cardiac Rehabilitatin
More informationFusilev (levoleucovorin) Document Number: IC-0183
Fusilev (levoleucovorin) Document Number: IC-0183 Last Review Date: 2/1/2018 Date of Origin: 01/02/2014 Dates Reviewed: 08/2014, 03/2015, 05/2015, 08/2015, 11/2015, 02/2016, 05/2016, 08/2016, 11/2016,
More informationWorkforce Data The American Board of Pediatrics
Workforce Data 2009-2010 The American Board of Pediatrics Caution. Before using this report as a resource, please read the information below! Please use caution when comparing data in this version of the
More informationBRAF Mutation Analysis
Last Review Date: October 13, 2017 Number: MG.MM.LA.38aC Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth
More informationRadiologic Therapeutic Procedures
Coverage Summary Radiologic Therapeutic Procedures Policy Number: R-003 Products: UnitedHealthcare Medicare Advantage Plans Original Approval Date: 04/02/2008 Approved by: UnitedHealthcare Medicare Benefit
More informationFederation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Foreign Educated PTs and PTAs
PT Requirements for Licensure Summary: Number of Jurisdictions that Require: Educational Credentials Review 50 from a program equivalent to CAPTE 37 Eligibility to practice in the country in which education
More information2016 COMMUNITY SURVEY
1 Epilepsy Innovation Institute (Ei ) 016 COMMUNITY SURVEY INTRODUCTION From September 8th to November 9th, 016, epilepsy.com hosted a survey that asked the community the following: What are the aspects
More informationNPCR CLINICAL EDIT CHECKS
NPCR CLINICAL EDIT CHECKS FCDS Annual Meeting July 26, 2013 Sunrise, Flrida Steven Peace, CTR FCDS Data Quality Staff PURPOSE OF CLINICAL EDIT CHECKS The primary purpse f the Clinical Check edits is t
More informationDrug Therapy Guidelines
Drug Therapy Guidelines Orencia (abatacept) Applicable Medical Benefit x Effective: 2/21/18 Pharmacy- Frmulary 1 x Next Review: 12/18 Pharmacy- Frmulary 2 x Date f Origin: 11/28/06 Pharmacy- Frmulary 3/Exclusive
More informationKhapzory (levoleucovorin) (Intravenous)
Khapzory (levoleucovorin) (Intravenous) Last Review Date: 12/04/2018 Date of Origin: 12/04/2018 Dates Reviewed: 12/2018 Document Number: IC-0408 I. Length of Authorization Coverage will be provided for
More informationFederation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Direct Access
Each licensing authority indicates the level of direct access allowed in the jurisdiction and the type of limitations that apply to this access. There are three tables: Types and Limits Specific Limits
More informationCLINICAL MEDICATION POLICY
CLINICAL MEDICATION POLICY Policy Name: Opdivo (nivolumab) injection Policy Number: Approved By: Medical Management, Clinical Pharmacy Products: Highmark Health Options Application: All participating hospitals
More informationSubject: Mohs Micrographic Surgery
02-10000-03 Original Effective Date: 05/15/02 Reviewed: 10/31/17 Revised: 10/01/18 Subject: Mhs Micrgraphic Surgery THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF
More informationRECOVERY SUPPORT SERVICES IN STATES
RECOVERY SUPPORT SERVICES IN STATES An analysis of State recovery support services using the 16 17 Substance Abuse Block Grant (SABG) Behavioral Health Assessment and Plan THIS PROJECT IS BEING SUPPORTED
More informationUsing Cancer Registry Data to Estimate the Percentage of Melanomas Attributable to UV Exposure
Using Cancer Registry Data to Estimate the Percentage of Melanomas Attributable to UV Exposure Meg Watson, MPH Epidemiologist NAACCR Annual Conference June 16, 2016 National Center for Chronic Disease
More informationFederation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: License Renewal. License Renewal on Birthdays
The table below lists information on the term and renewal date for each jurisdiction. Summary License Term 1 26 2 Renewal Date One date 31 Birthdays 6 Half in even years 4 4 License Term AL AK AZ AR CA
More informationBY-STATE MENTAL HEALTH SERVICES AND EXPENDITURES IN MEDICAID, 1999
STATE-BY BY-STATE MENTAL HEALTH SERVICES AND EXPENDITURES IN MEDICAID, 1999 James Verdier,, Ann Cherlow,, and Allison Barrett Mathematica Policy Research, Inc. Jeffrey Buck and Judith Teich Substance Abuse
More informationFederation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Foreign Educated Physical Therapists
Requirements for Licensure Summary: Number of Jurisdictions that Require: Educational Credentials Review 50 Graduation from a program equivalent to CAPTE 37 Eligibility to practice in the country in which
More informationDrug Therapy Guidelines
Applicable* Medical Benefit x Effective: 2/15/19 Pharmacy- Frmulary 1 Next Review: 12/19 Pharmacy- Frmulary 2 Date f Origin: 4/1/05 Pharmacy- Frmulary 3/Exclusive Review Dates: 4/1/05, 2/1/06, 10/15/06,
More informationSUMMACARE COMMERCIAL MEDICATION REQUEST GUIDELINES. ANTI-OBESITY AGENTS Generic Brand HICL GCN Exception/Other QSYMIA 32515, 32744, 32746, 32745
Generic Brand HICL GCN Exceptin/Other NALTREXONE CONTRAVE ER 41389 /BUPROPION LORCASERIN BELVIQ 34733 PHENTERMINE PHENTERMINE 20691 20692 20693 20713 PHENTERMINE LOMAIRA 20715 PHENTERMINE/TO PIRAMATE GUIDELINES
More informationDrug Therapy Guidelines
Drug Therapy Guidelines Applicable* Hereditary Angiedema (HAE) Agents: Berinert (C1 esterase inhibitr [human]), Cinryze (C1 esterase inhibitr [human]), Haegarda (C1 esterase inhibitr [human]) Kalbitr (ecallantide),
More informationUSA National Mental Healthcare Nonprofit Exempt Organization Financial Analysis as of December 14, 2015 January 24, 2016 ANSA-H2
USA National Mental Healthcare Nonprofit Exempt Organization Financial Analysis as of December 14, 2015 January 24, 2016 ANSA-H2 Prepared by David Yoo, HanaSoul Consulting, Omaha, Nebraska dcyoo@cox.net
More informationHow to Get Paid for Doing EBD
How to Get Paid for Doing EBD Robert D. Compton, DDS President Robert Compton, DDS Executive Director DentaQuest Institute Disclosure DentaQuest Institute President DentaQuest Benefits Senior VP & CDO
More informationConsiderations for State Obesity Policy
Considerations for State Obesity Policy Scott Kahan, MD, MPH Faculty, Johns Hopkins Bloomberg School of Public Health Director, National Center for Weight & Wellness Clinical Director, STOP Obesity Alliance,
More informationRelated Policies None
Medical Plicy MP 3.01.501 Guidelines fr Cverage f Mental and Behaviral Health Services Last Review: 8/30/2017 Effective Date: 8/30/2017 Sectin: Mental Health End Date: 08/19/2018 Related Plicies Nne DISCLAIMER
More informationKeytruda (pembrolizumab) (Intravenous)
Keytruda (pembrolizumab) (Intravenous) Last Review Date: 02/06/2018 Date of Origin: 09/30/2014 Document Number: IC-0209 Dates Reviewed: 9/2014, 3/2015, 5/2015, 8/2015, 10/2015, 11/2015, 2/2016, 5/2016,
More informationCLINICAL MEDICAL POLICY
Plicy Name: Plicy Number: Respnsible Department(s): CLINICAL MEDICAL POLICY Supervised Exercise Therapy fr Peripheral Artery Disease (PAD) MP-077-MD-DE Medical Management Prvider Ntice Date: 01/15/2019
More informationCoverage Summary. Wound Treatments
Coverage Summary Wound Treatments Policy Number: W-001 Products: UnitedHealthcare Medicare Advantage Plans Original Approval Date: 02/18/2009 Approved by: UnitedHealthcare Medicare Benefit Interpretation
More informationRequest for Prior Authorization for Click here to enter text. Website Form Submit request via: Fax
Request fr Prir Authrizatin fr Click here t enter text. Website Frm www.highmarkhealthptins.cm Submit request via: Fax - 1-855-476-4158 Updated: 05/2018 DMMA Apprved: 05/2018 All requests fr Intravenus
More informationThe Affordable Care Act and HIV: What are the Implications?
The Affordable Care Act and HIV: What are the Implications? 2013 National Black AIDS Institute Webinar Series September 18, 2013 Jen Kates, Kaiser Family Foundation The Challenge Figure 1 30 years into
More informationState of California Department of Justice. Bureau of Narcotic Enforcement
State of California Department of Justice Bureau of Narcotic Enforcement Prescription Drugs in the U.S. At least half of all Americans take one prescription drug regularly, with one in six taking three
More informationArkansas Prescription Monitoring Program
Arkansas Prescription Monitoring Program FY 2016 Third Quarter Report January-March 2016 Arkansas Prescription Monitoring Program Quarterly Report January March, Fiscal year 2016 Act 304 of 2011 authorized
More informationSimponi ARIA (golimumab) (Intravenous)
Simponi ARIA (golimumab) (Intravenous) Last Review Date: 10/31/2017 Date of Origin: 09/05/2013 Document Number: MODA-0176 Dates Reviewed: 12/2013, 8/2014, 3/2015, 6/2015, 9/2015, 12/2015, 3/2016, 6/2016,
More informationHealth Science Ch. 16 Cancer Lecture Outline
Cancer Leading cause f disease-related death amng peple under age 75 Secnd leading cause f death Evidence supprts that mst cancers culd be prevented by simple lifestyle changes Tbacc is respnsible fr abut
More informationBiology 30S Unit Test Review: Digestion
Bilgy 30S Unit Test Review: Digestin Test utline: Multiple Chice: 10 Questins, 1 mark each. Shrt Answer: 5 Questins (answer 3 f them), 5 marks each. Lng Answer: 2 Lng Answer Questins, 10 marks each. Tasks
More informationActivating the patient s immune system to fight. system to. Company presentation. fight cancer. Company presentation. August November
Activating the patient s the immune system t fight immune cancer system t Cmpany presentatin fight cancer Cmpany presentatin August Nvember 2018 2018 IMPORTANT NOTICE AND DISCLAIMER This reprt cntains
More informationMedical Policy Title: HDC & Autologous ARBenefits Approval: 02/08/2012
Medical Plicy Title: HDC & Autlgus ARBenefits Apprval: 02/08/2012 Stem&/r Prgenitr Cell Supprt, Germ Cell Tumrs Effective Date: 01/01/2013 Dcument: ARB0416:01 Revisin Date: 10/24/2012 Cde(s): 38230, Bne
More informationFour categories which guide further evaluation
Unknwn Primary Updated May 2017 by Di Maria Jiang (PGY-5 Medical Onclgy Resident, University f Trnt) Reviewed by Dr. Chistine Elser (Staff Medical Onclgist, University f Trnt) and Dr. Sct Dwden (Staff
More informationCRITERIA FOR USE: Requires Prior Authorization by Medical Director or Designee
What s New Medical Pharmaceutical Plicy September Updates 2017 MBP 154.0 Radicava (edaravne)- New Plicy CRITERIA FOR USE: Requires Prir Authrizatin by Medical Directr r Designee Radicava (edaravne) will
More informationSolid Organ Transplant Benefits to Change for Texas Medicaid
Slid Organ Transplant Benefits t Change fr Texas Medicaid Infrmatin psted February 13, 2015 Nte: All new and updated prcedure cdes and their assciated reimbursement rates are prpsed benefits pending a
More informationDifferent Types of Cancer
Different Types of Cancer Cancer can originate almost anywhere in the body. Sarcomas (connective tissue) Ø arise from cells found in the supporting tissues of the body such as bone, cartilage, fat, connective
More informationConsensus and Collaboration
Consensus and Collaboration John Morton, MD, MPH, FACS, FASMBS Chief, Bariatric & Minimally Invasive Surgery Stanford School of Medicine Past-President, American Society of Metabolic and Bariatric Surgery,
More informationHIP REPLACEMENT SURGERY (ARTHROPLASTY)
Prtcl: ORT015 Effective Date: June 1, 2017 HIP REPLACEMENT SURGERY (ARTHROPLASTY) Table f Cntents Page COMMERCIAL & MEDICAID COVERAGE RATIONALE... 1 MEDICARE COVERAGE RATIONALE... 3 U.S.FOOD AND DRUG ADMINISTRATION
More informationArkansas Prescription Monitoring Program
Arkansas Prescription Monitoring Program FY 2017 Second Quarter Report October December 2016 Arkansas Prescription Monitoring Program Quarterly Report October December, Fiscal year 2017 Act 304 of 2011
More informationOriginal Policy Date
MP 7.01.113 Orthgnathic Surgery Medical Plicy Sectin Surgery Issue 12/2013 Original Plicy Date 12/2013 Last Review Status/Date Lcal Plicy created 12/2013 Return t Medical Plicy Index Disclaimer Our medical
More informationContinuous Positive Airway Pressure (CPAP) and Respiratory Assist Devices (RADs) including Bi-Level PAP
Cntinuus Psitive Airway Pressure (CPAP) and Respiratry Assist Devices (RADs), Including Bi-Level PAP Benefit Criteria t Change fr Texas Medicaid Effective March 1, 2017 Overview f Benefit Changes Benefit
More informationVoluntary Mental Health Treatment Laws for Minors & Length of Inpatient Stay. Tori Lallemont MPH Thesis: Maternal & Child Health June 6, 2007
Voluntary Mental Health Treatment Laws for Minors & Length of Inpatient Stay Tori Lallemont MPH Thesis: Maternal & Child Health June 6, 2007 Introduction 1997: Nearly 300,000 children were admitted to
More informationDental ER Visits: Evidence of a Failed System. Shelly Gehshan AACDP Conference April 29, 2012
Dental ER Visits: Evidence of a Failed System Shelly Gehshan AACDP Conference April 29, 2012 Overview of Pew s s findings Preventable dental conditions were the primary diagnosis in 830,590 visits to hospital
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Erbitux) Reference Number: CP.PHAR.317 Effective Date: 02.01.17 Last Review Date: 11.18 Line of Business: Commercial, HIM, Medicaid Coding Implications Revision Log See Important Reminder
More informationUS Public Health Service Clinical Practice Guidelines for PrEP
Webcast 1.3 US Public Health Service Clinical Practice Guidelines fr PrEP P R E S ENTED BY: M A R K T H R U N, M D A S S O C I AT E P R O F E S S O R, U N I V E R S I T Y O F C O L O R A D O, D I V I S
More informationClinical Policy: Cetuximab (Erbitux) Reference Number: PA.CP.PHAR.317
Clinical Policy: (Erbitux) Reference Number: PA.CP.PHAR.317 Effective Date: 01/18 Last Review Date: 11/17 Coding Implications Revision Log Description The intent of the criteria is to ensure that patients
More informationP02-03 CALA Program Description Proficiency Testing Policy for Accreditation Revision 1.9 July 26, 2017
P02-03 CALA Prgram Descriptin Prficiency Testing Plicy fr Accreditatin Revisin 1.9 July 26, 2017 P02-03 CALA Prgram Descriptin Prficiency Testing Plicy fr Accreditatin TABLE OF CONTENTS TABLE OF CONTENTS...
More information