SCIG: Hizentra, Gammagard Liquid, Gamunex -C, Gammaked, Hyqvia, Cuvitru (immune globulin SQ)
|
|
- Winfred Ferguson
- 5 years ago
- Views:
Transcription
1 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, 3/2011, 6/2011, 9/2011, 12/2011, 3/2012, 6/2012, 9/2012, 12/2012, 3/2013, 6/2013, 9/2013, 12/2013, 3/2014, 9/2014, 12/2014, 3/2015, 6/2015, 9/2015, 12/2015, 3/2016, 6/2016, 9/2016, 12/2016, 3/2017, 6/2017, 9/2017, 12/2017, 03/2018, 04/2018 I. Length f Authrizatin Initial cverage will be prvided fr 6 mnths and may be renewed annually thereafter. II. Dsing Limits A. Quantity Limit (max daily dse) [Pharmacy Benefit]: Drug Name Dse/ week Dse/28 days Hizentra 46 g 184 g Gamunex-C & Gammaked 24 g 96 g Gammagard liquid 24 g 96 g HyQvia 17.5 g 69 g Cuvitru 23 g 92 g B. Max Units (per dse and ver time) [Medical Benefit]: Drug Name Billable units/28 days Hizentra 960 (PID) 1840 (CIDP) Gamunex-C & Gammaked 192 Gammagard liquid 192 HyQvia 690 Cuvitru 920 III. Initial Apprval Criteria Baseline values fr BUN and serum creatinine btained within 30 days f request; AND Cverage is prvided in the fllwing cnditins: Primary immundeficiency (PID)/Wisktt -Aldrich syndrme Such as: x-linked agammaglbulinemia, cmmn variable immundeficiency, transient hypgammaglbulinemia f infancy, IgG subclass deficiency with r withut IgA deficiency, antibdy deficiency with near nrmal immunglbulin levels) and cmbined deficiencies (severe Mda Health Plan, Inc. Medical Necessity Criteria Page 1/8
2 cmbined immundeficiencies, ataxia-telangiectasia, x-linked lymphprliferative syndrme) [list nt all inclusive] Fr HyQvia ONLY: Patient must be 18 years ld; AND Patient s IgG level is <200 mg/dl OR bth f the fllwing Patient has a histry f multiple hard t treat infectins as indicated by at least ne f the fllwing: Fur r mre ear infectins within 1 year Tw r mre serius sinus infectins within 1 year Tw r mre mnths f antibitics with little effect Tw r mre pneumnias within 1 year Recurrent r deep skin abscesses Need fr intravenus antibitics t clear infectins Tw r mre deep-seated infectins including septicemia; AND The patient has a deficiency in prducing antibdies in respnse t vaccinatin; AND Titers were drawn befre challenging with vaccinatin; AND Titers were drawn between 4 and 8 weeks f vaccinatin Chrnic Inflammatry Demyelinating Plyneurpathy (CIDP) [Hizentra ONLY] Patient must be 18 years ld; AND Physician has assessed baseline disease severity utilizing an bjective measure/tl; AND Used as initial maintenance therapy fr preventin f disease relapses after treatment and stabilizatin with intravenus immunglbulin (IVIG) ; OR Used fr re-initiatin f maintenance therapy after experiencing a relapse and requiring re-inductin therapy with IVIG (see Sectin IV fr criteria) Initial IVIG criteria used fr determinatin f cverage: (Reference Use Only) Patient s disease curse is prgressive r relapsing and remitting fr 2 mnths r lnger; AND Patient has abnrmal r absent deep tendn reflexes in upper r lwer limbs; AND Electrdiagnstic testing indicating demyelinatin: Partial mtr cnductin blck in at least tw mtr nerves r in 1 nerve plus ne ther demyelinatin criterin listed here in at least 1 ther nerve; OR Distal CMAP duratin increase in at least 1 nerve plus ne ther demyelinatin criterin listed here in at least 1 ther nerve; OR Abnrmal tempral dispersin cnductin must be present in at least 2 mtr nerves; OR Reduced cnductin velcity in at least 2 mtr nerves; OR Prlnged distal mtr latency in at least 2 mtr nerves; OR Absent F wave in at least tw mtr nerves plus ne ther demyelinatin criterin listed here in at least 1 ther nerve; OR Prlnged F wave latency in at least 2 mtr nerves; AND Cerebrspinal fluid analysis indicates the fllwing: CSF white cell cunt f <10 cells/mm 3 ; AND CSF prtein is elevated; AND Mda Health Plan, Inc. Medical Necessity Criteria Page 2/8
3 Patient is refractry r intlerant t crticsterids (e.g., prednislne, prednisne, etc.) given in therapeutic dses ver at least three mnths; AND Baseline in strength/weakness has been dcumented using an bjective clinical measuring tl (e.g., INCAT, Medical Research Cuncil (MRC) muscle strength, 6-MWT, Rankin, Mdified Rankin, etc.) FDA Apprved Indicatin(s) IV. Renewal Criteria Cverage can be renewed fr 1 year based upn the fllwing criteria: Patient cntinues t meet criteria identified in sectin III; AND Absence f unacceptable txicity frm the drug; AND BUN and serum creatinine btained within the last 6 mnths and the cncentratin and rate f infusin have been adjusted accrdingly; AND Primary immundeficiency (PID)/Wisktt -Aldrich syndrme Disease respnse as evidenced by ne r mre f the fllwing: Decrease in the frequency f infectin Decrease in the severity f infectin Chrnic Inflammatry Demyelinating Plyneurpathy (CIDP) Renewals will be authrized fr patients that have demnstrated a beneficial clinical respnse t maintenance therapy, withut relapses, based n an bjective clinical measuring tl; OR Patient is re-initiating maintenance therapy after experiencing a relapse while n Hizentra; AND V. Dsage/Administratin Patient imprved and stabilized n IVIG treatment: AND Patient was NOT receiving maximum dsing f Hizentra prir relapse Dsing shuld be calculated using adjusted bdy weight if ne r mre f the fllwing criteria are met: Patient s bdy mass index (BMI) is 30 kg/m 2 r mre; OR Patient s actual bdy weight is 20% higher than his r her ideal bdy weight (IBW) Use the fllwing dsing frmulas t calculate the adjusted bdy weight (rund dse t nearest 5 gram increment in adult patients) BMI = 703 x (weight in punds/height in inches 2 ) IBW(kg) fr males = 50 + [2.3 (height in inches 60)] Dsing frmulas IBW(kg) fr females = [2.3 x (height in inches 60)] Adjusted bdy weight = IBW (actual bdy weight IBW) This infrmatin is nt meant t replace clinical decisin making when initiating r mdifying medicatin therapy and shuld nly be used as a guide. Patient-specific variables shuld be taken int accunt. Mda Health Plan, Inc. Medical Necessity Criteria Page 3/8
4 Indicatin Dse Chrnic Inflammatry Demyelinating Plyneurpathy Primary immune deficiency including Wisktt-Aldrich Syndrme Hizentra ONLY: Initiate therapy 1 week after the last IVIG dse The recmmended subcutaneus dse is 0.2 g/kg (1 ml/kg) bdy weight per week, administered in 1 r 2 sessins ver 1 r 2 cnsecutive days. If CIDP symptms wrsen, cnsider re-initiating treatment with an IVIG while discntinuing Hizentra. Hizentra: If imprvement and stabilizatin are bserved during IVIG treatment, cnsider reinitiating Hizentra at the dse f 0.4 g/kg bdy weight per week, administered in 2 sessins per week ver 1 r 2 cnsecutive days, while discntinuing IVIG. If CIDP symptms wrsen n the 0.4 g/kg bdy weight per week dse, cnsider reinitiating therapy with an IVIG while discntinuing Hizentra. Weekly dse: 1.37*(previus IVIG dse(g)/number f weeks between IVIG dses) Biweekly dse: twice the weekly dse (using calculatin abve) Gamunex-C/Gammaked/Gammagard Liquid: Weekly dse: 1.37*(previus IVIG dse(g)/number f weeks between IVIG dses) HyQvia: Naïve t IgG r switching frm SCIG: 300 t 600 mg/kg at 3 t 4 week intervals after initial ramp-up* Switching frm IGIV: use the same dse and frequency as the previus IV treatment after initial ramp-up* Cuvitru: Switching frm IVIG r HyQvia: Weekly dse: 1.30*(previus IVIG r HyQvia dse (g)/number f weeks between IVIG r HyQvia dses) May be administered frm daily up t every tw weeks (biweekly) Biweekly dse: twice the weekly dse (using calculatin abve) Frequent dsing (2-7 times per week): divide the calculated weekly dse by the desired number f times per week Switching frm SCIG Weekly dse (in grams) shuld be same as the weekly dse f prir SCIG treatment (in grams) Biweekly dse: multiply the calculated weekly dse by 2 Frequent dsing (2-7 times per week): divide the calculated weekly dse by the desired number f times per week Dsing fr immunglbulin prducts is highly variable depending n numerus patient specific factrs, indicatin(s), and the specific prduct selected. Fr specific dsing regimens refer t current prescribing literature. *HyQvia initial treatment interval/dsage ramp-up schedule Week Infusin Number 3-week treatment interval 4-week treatment interval 1 1 st infusin Dse in Grams X 0.33 Dse in Grams X 0.25 Mda Health Plan, Inc. Medical Necessity Criteria Page 4/8
5 Week Infusin Number 3-week treatment interval 4-week treatment interval 2 2 nd infusin Dse in Grams X 0.67 Dse in Grams X rd infusin Ttal Dse in Grams Dse in Grams X th infusin N/A Ttal Dse in Grams VI. Billing Cde/Availability Infrmatin HCPCS cde & NDC: Drug Name Manufacturer HCPCS Cde 1 Billable NDC IgG Vlume unit (grams) (ml) Hizentra 20% CSL Behring AG J1559 Injectin, immune glbulin (Hizentra), 100 mg 100 mg Gammaked 10% Kedrin Bipharma, Inc. J1561 Injectin, immune glbulin, (Gamunex-C/Gammaked), nn-lyphilized (e.g. liquid), 500 mg 500 mg Gamunex-C 10% Grifls Therapeutics J1561 Injectin, immune glbulin, (Gamunex-C/Gammaked), nn-lyphilized (e.g. liquid), 500 mg 500 mg Gammagard Liquid 10% Baxter Healthcare Crpratin J1569 Injectin, immune glbulin, (Gammagard liquid), nnlyphilized, (e.g. liquid), 500 mg 500 mg HyQvia 10% (with Recmbinant Human Hyalurnidase 160 U/mL) Baxter Healthcare Crpratin J1575 Injectin, immune glbulin/hyalurnidase, (Hyqvia), 100 mg immune glbulin 100 mg Cuvitru 20% Baxalta US Inc. J1555 Injectin, immune glbulin (Cuvitru), 100 mg 100 mg Immune Glbulin, Human, Subcutaneus N/A J3590 unclassified bilgic immune glbulin (SCIg), human, fr use in subcutaneus infusins N/A N/A N/A N/A Mda Health Plan, Inc. Medical Necessity Criteria Page 5/8
6 VII. References 1. Hizentra [package insert]. Bern, Switzerland; CSL Behring AG; March Accessed March HyQvia [package insert]. Westlake Village, CA; Baxter Healthcare Crpratin; September Accessed January Cuvitru [package insert]. Westlake Village, CA; Baxalta US Inc.; September Accessed January Gammagard Liquid [package insert]. Westlake Village, CA; Baxter Healthcare Crpratin; June Accessed January Gamunex -C [package insert]. Research Triangle, NC; Grifls Therapeutics, Inc.; March Accessed January Gammaked [package insert]. Research Triangle, NC; Grifls Therapeutics, Inc.; September Accessed January Jeffrey Mdell Fundatin Medical Advisry Bard, Warning Signs f Primary Immundeficiency. Jeffrey Mdell Fundatin, New Yrk, NY 8. Orange J, Hssny E, Weiler C, et al. Use f intravenus immunglbulin in human disease: A review f evidence by members f the Primary Immundeficiency Cmmittee f the American Academy f Allergy, Asthma and Immunlgy. J Allergy Clin Immunl 2006;117(4 Suppl): S Orange JS, Ballw M, Stiehm, et al. Use and interpretatin f diagnstic vaccinatin in primary immundeficiency: A wrking grup reprt f the Basic and Clinical Immunlgy Interest Sectin f the American Academy f Allergy, Asthma & Immunlgy. J Allergy Clin Immunl Vl 130 (3). 10. Bnilla FA, Khan DA, Ballas ZK, et al. Practice Parameter fr the diagnsis and management f primary immundeficiency. J Allergy Clin Immunl 2015 Nv;136(5): e Emersn GG, Herndn CN, Sreih AG. Thrmbtic cmplicatins after intravenus immunglbulin therapy in tw patients. Pharmactherapy. 2002;22: Department f Health (Lndn). Clinical Guidelines fr Immunglbulin Use: Update t Secnd Editin. August, Prvan, Drew, et al. "Clinical guidelines fr immunglbulin use." Department f Health Publicatin, Lndn (2008). 14. Dantal J. Intravenus Immunglbulins: In-Depth Review f Excipients and Acute Kidney Injury Risk. Am J Nephrl 2013;38: Immune Deficiency Fundatin. Diagnstic & Clinical Care Guidelines fr Primary Immundeficiency Diseases. 3 rd Ed Avail at: Guidelines-fr-PI_1.pdf. 16. First Cast Service Optins, Inc. Lcal Cverage Determinatin (LCD): Intravenus Immune Glbulin (L34007). Centers fr Medicare & Medicaid Services, Inc. Updated n 1/5/2018 with effective date 1/1/2018. Accessed March Wiscnsin Physicians Service Insurance Crpratin. Lcal Cverage Determinatin (LCD): Immune Glbulins (L34771). Centers fr Medicare & Medicaid Services, Inc. Updated n 12/19/2017 with effective date 1/1/2018. Accessed March Appendix 1 Cvered Diagnsis Cdes Mda Health Plan, Inc. Medical Necessity Criteria Page 6/8
7 ICD-10 B20 ICD-10 Descriptin Human immundeficiency virus [HIV] disease D80.0 Hereditary hypgammaglbulinemia D80.1 Nnfamilial hypgammaglbulinemia D80.2 Selective deficiency f immunglbulin A [IgA] D80.3 Selective deficiency f immunglbulin G [IgG] subclasses D80.4 Selective deficiency f immunglbulin M [IgM] D80.5 Immundeficiency with increased immunglbulin M [IgM] D80.7 Transient hypgammaglbulinemia f infancy D81.0 Severe cmbined immundeficiency [SCID] with reticular dysgenesis D81.1 Severe cmbined immundeficiency [SCID] with lw T- and B-cell numbers D81.2 Severe cmbined immundeficiency [SCID] with lw r nrmal B-cell numbers D81.6 Majr histcmpatibility cmplex class I deficiency D81.7 Majr histcmpatibility cmplex class II deficiency D81.89 Other cmbined immundeficiencies D81.9 Cmbined immundeficiency, unspecified D82.0 Wisktt-Aldrich syndrme D83.0 Cmmn variable immundeficiency with predminant abnrmalities f B-cell numbers and functin D83.2 Cmmn variable immundeficiency with autantibdies t B- r T-cells D83.8 Other cmmn variable immundeficiencies D83.9 Cmmn variable immundeficiency, unspecified G61.81 Chrnic inflammatry demyelinating plyneuritis G61.89 Other inflammatry plyneurpathies G62.89 Other specified plyneurpathies 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/Article Dcument (s): L Mda Health Plan, Inc. Medical Necessity Criteria Page 7/8
8 Jurisdictin(s): 5, 8 NCD/LCD/Article Dcument (s): L 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 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 Palmett GBA, 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 8/8
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 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 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 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 informationSCIG: (Immune globulin SQ) Hizentra, Vivaglobin, Gammagard Liquid, Gamunex- C, Gammaked, Hyqvia Page 1 of 6
Moda Health Plan, Inc. Medical Necessity Criteria Subject: Origination Date: 04/1 Revision Date(s): 02/16 Developed By: Medical Criteria Committee Effective Date: 0/01/1 SCIG: (Immune globulin SQ) Hizentra,
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 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 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 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 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 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 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 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 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 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 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 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 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 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 informationDrug Therapy Guidelines
Drug Therapy Guidelines Applicable Medical Benefit x Effective: 5/1/18 Pharmacy- Frmulary 1 x Next Review: 6/18 Pharmacy- Frmulary 2 x Date f Origin: 11/07 Immune Glbulins Intravenus: Carimune NF, Flebgamma,
More informationImmune Globulins (immunoglobulin) (Intravenous)
Immune Glbulins (immunglbulin) (Intravenus) Last Review Date: 09/05/2018 Date f Origin: 07/20/2010 Dcument Number: MODA-0071 Dates Reviewed: 09/2010, 12/2010, 02/2011, 03/2011, 06/2011, 09/2011, 10/2011,
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 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 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 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 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 informationMust be used as initial treatment as a single agent with sequential chemoradiation
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,
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 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 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 informationOriginal Policy Date 12:2013
MP 5.01.18 Xlair (Omalizumab) Medical Plicy Sectin Prescriptin Drugs Issu12:2013e 4:2006 Original Plicy Date 12:2013 Last Review Status/Date Lcal plicy/12:2013 Return t Medical Plicy Index Disclaimer Our
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 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 informationITP typically presents with the sudden appearance of a petechial rash, spontaneous bruising and/or bleeding in an otherwise well child.
Acute Immune Thrmbcytpenia Purpura (ITP) Backgrund Primary immune thrmbcytpenia (ITP) is an acquired immune mediated disrder characterised by islated thrmbcytpenia, defined as a peripheral bld platelet
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 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 informationWound Care Equipment and Supply Benefits to Change for Texas Medicaid July 1, 2018
Wund Care Equipment and Supply Benefits t Change fr Texas Medicaid July 1, 2018 Infrmatin psted May 11, 2018 Nte: Texas Medicaid managed care rganizatins (MCOs) must prvide all medically necessary, Medicaid-cvered
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 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 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 informationIntravenous Vancomycin Use in Adults Intermittent (Pulsed) Infusion
Intravenus Vancmycin Use in Adults Intermittent (Pulsed) Infusin Backgrund This plicy cvers the use f intravenus vancmycin prescribed as an intermittent (pulsed) infusin. This can be used fr treatment
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 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 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 informationIntravenous Vancomycin Use in Adults Intermittent (Pulsed) Infusion
Backgrund This plicy cvers the use f intravenus vancmycin prescribed as an intermittent (pulsed) infusin. This can be used fr treatment r prphylaxis. Evidence supprting this guidance is detailed belw.
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 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 informationMy Symptoms and Medical History for Adult Chronic Immune Thrombocytopenia (ITP)
My Symptms and Medical Histry fr Adult Chrnic Immune Thrmbcytpenia (ITP) Call t talk t a registered nurse 1-855-7Nplate (1-855-767-5283), Mnday Friday, 9:00 AM 9:00 PM ET Indicatin Nplate is a man-made
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 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 informationBenefits for Anesthesia Services for the CSHCN Services Program to Change Effective for dates of service on or after July 1, 2008, benefit criteria
Benefits fr Anesthesia Services fr the CSHCN Services Prgram t Change Effective fr dates f service n r after July 1, 2008, benefit criteria fr anesthesia will change fr the Children with Special Health
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 informationThis clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.
abcd Clinical Study Synpsis fr Public Disclsure This clinical study synpsis is prvided in line with Behringer Ingelheim s Plicy n Transparency and Publicatin f Clinical Study Data. The synpsis which is
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 informationLEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY/APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER HAWAII MEDICAID QUEST
OPTUM LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY / APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER HAWAII MEDICAID QUEST LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY/APPLIED
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 informationOTHER AND UNSPECIFIED DISORDERS
OPTUM COVERAGE DETERMINATION GUIDELINE OTHER AND UNSPECIFIED DISORDERS Guideline Number: BH727OUD_102017 Effective Date: Octber, 2017 Table f Cntents Page INSTRUCTIONS FOR USE... 1 BENEFIT CONSIDERATIONS...
More informationWidening of funding restrictions for rituximab and eltrombopag
20 February 2014 Widening f funding restrictins fr rituximab and eltrmbpag PHARMAC is pleased t annunce the apprval f prpsals t widen the restrictin n rituximab use in DHB hspitals and expand the funding
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 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 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 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 informationIMMUNE GLOBULIN (IVIG AND SCIG)
IMMUNE GLOBULIN (IVIG AND SCIG) UnitedHealthcare Oxfrd Clinical Plicy Plicy Number: PHARMACY 033.43 T2 Effective Date: February 1, 2018 Table f Cntents Page INSTRUCTIONS FOR USE... 1 CONDITIONS OF COVERAGE...
More informationObesity/Morbid Obesity/BMI
Obesity/mrbid besity/bdy mass index (adult) Obesity/Mrbid Obesity/BMI Definitins and backgrund Diagnsis cde assignment is based n the prvider s clinical judgment and crrespnding medical recrd dcumentatin
More informationWARNING: FATAL AND SERIOUS TOXICITIES: SEVERE DIARRHEA AND CARDIAC TOXICITIES
INDICATION FARYDAK (panbinstat) capsules, a histne deacetylase inhibitr, in cmbinatin with brtezmib and dexamethasne, is indicated fr the treatment f patients with multiple myelma wh have received at least
More informationNCT ClinialTrials.gov Identifier: sanofi-aventis. Sponsor/company: PRIST_L_ Study Code: PRISTINAMYCIN Date: Generic drug name:
These results are supplied fr infrmatinal purpses nly. Prescribing decisins shuld be made based n the apprved package insert in the cuntry f prescriptin Spnsr/cmpany: sanfi-aventis ClinialTrials.gv Identifier:
More informationHigh Performance Network Quality Criteria for Designation
Selected quality measures include: Specialty Measure Descriptin Allergy / Immunlgy Asthma Drug Mgt Vaccine Pneumnia Vaccine High Perfrmance Netwrk Quality Criteria fr Designatin AvMed has selected certain
More informationAnnex III. Amendments to relevant sections of the Product Information
Changes t the Prduct infrmatin as apprved by the CHMP n 13 Octber 2016, pending endrsement by the Eurpean Cmmissin Annex III Amendments t relevant sectins f the Prduct Infrmatin Nte: These amendments t
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 informationReferral Criteria: Inflammation of the Spine Feb
Referral Criteria: Inflammatin f the Spine Feb 2019 1 5.7. Inflammatin f the Spine Backgrund Ankylsing spndylitis and axial spndylarthrpathy are fund in arund 0.3-1.2% f the ppulatin. Spndylarthritis encmpasses
More informationBariatric Surgery FAQs for Employees in the GRMC Group Health Plan
Bariatric Surgery FAQs fr Emplyees in the GRMC Grup Health Plan Gergia Regents Medical Center and Gergia Regents Medical Assciates emplyees and eligible dependents wh are in the GRMC Grup Health Plan (Select
More informationImportant Information
Grup Health Pharmacy Administratin GSE-B2N-02 2921 Naches Ave SW PO Bx 9009 Rentn, WA 98057-9009 Grup Health Cperative Grup Health Optins, Inc. ghc.rg Imprtant Infrmatin February 6, 2017 Dear Prvider,
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 informationHealth Screening Record: Entry Level Due: August 1st MWF 150 Entry Year
Health Screening Recrd: Entry Level MIDWIFERY EDUCATION PROGRAM HEALTH SCREENING REQUIREMENTS (Rev. June 2017) 1. Hepatitis B: Primary vaccinatin series (3 vaccines 0, 1 and 6 mnths apart), plus serlgic
More informationNational Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For PA Health & Wellness Providers
Natinal Imaging Assciates, Inc. (NIA) Frequently Asked Questins (FAQ s) Fr PA Health & Wellness Prviders Questin GENERAL Why is PA Health & Wellness implementing a Medical Specialty Slutins Prgram? Answer
More informationMEDICATION GUIDE LEMTRADA (lem-tra-da) (alemtuzumab) Injection for intravenous infusion
MEDICATION GUIDE LEMTRADA (lem-tra-da) (alemtuzumab) Injectin fr intravenus infusin Read this Medicatin Guide befre yu start receiving LEMTRADA and befre yu begin each treatment curse. There may be new
More informationNew Exception Status Benefits
FEBRUARY 2019 Nva Sctia Frmulary Updates New Exceptin Status Benefits Prcysbi (cysteamine bitartrate) Nucala (meplizumab) Ocaliva (betichlic acid) Ravicti (glycerl phenylbutyrate) Taltz (ixekizumab) Criteria
More informationIMMUNE GLOBULIN (IVIG AND SCIG)
Oxfrd IMMUNE GLOBULIN (IVIG AND SCIG) UnitedHealthcare Oxfrd Clinical Plicy Plicy Number: PHARMACY 033.48 T2 Effective Date: April 1, 2019 Instructins fr Use Table f Cntents Page CONDITIONS OF COVERAGE...
More informationHIV Diagnostic Tests. HIV Testing Algorithm at SydPath (National Reference Laboratory)
HIV Diagnstic Tests HIV Testing Algrithm at SydPath (Natinal Reference Labratry) HIV1/2 Ab/Ag Cmbi is Architect HIV- 1 Ab/Ag EIA is Genscreen Sandwich EIA 4 th Generatin HIV Ab/Ag Chemiluminescene Micr
More informationCONSENT FOR KYBELLA INJECTABLE FAT REDUCTION
CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION INSTRUCTIONS This is an infrmed cnsent dcument which has been prepared t help yur Dctr infrm yu cncerning fat reductin with an injectable medicatin, its risks,
More informationQ 5: Is relaxation training better (more effective than/as safe as) than treatment as usual in adults with depressive episode/disorder?
updated 2012 Relaxatin training Q 5: Is relaxatin training better (mre effective than/as safe as) than treatment as usual in adults with depressive episde/disrder? Backgrund The number f general health
More informationPROVIDER ALERT. Comprehensive Diagnostic Evaluation (CDE) Guidelines to Access the Applied Behavior Analysis (ABA) Benefit.
Cmprehensive Diagnstic Evaluatin (CDE) Guidelines t Access the Applied Behavir Analysis (ABA) Benefit May 5, 2017 Clinical infrmatin that utlines medical necessity is required t supprt the need fr initial
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 information2017 Optum, Inc. All rights reserved BH1124_112017
1) What are the benefits t clients f encuraging the use f MAT? Withut MAT, 90% f individuals with Opiid Use Disrder (OUD) will relapse within ne year. With MAT, the relapse rate fr thse with OUD decreases
More informationFrequently Asked Questions: IS RT-Q-PCR Testing
Questins 1. What is chrnic myelid leukemia (CML)? 2. Hw des smene knw if they have CML? 3. Hw is smene diagnsed with CML? Frequently Asked Questins: IS RT-Q-PCR Testing Answers CML is a cancer f the bld
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 informationLow Molecular Weight Heparin Prescribing and Administration (Adults)
Clinical guideline Lw Mlecular Weight Heparin Prescribing and Administratin (Adults) The Natinal Patient Safety Agency issued guidance n ways f reducing dsing errrs when prescribing lw mlecular weight
More informationChildhood Immunization Status (NQF 0038)
Childhd Immunizatin Status (NQF 0038) EMeasure Name Childhd Immunizatin EMeasure Id Pending Status Versin Number 1 Set Id Pending Available Date N infrmatin Measurement Perid January 1, 20xx thrugh December
More informationMethadone Maintenance Treatment for Opioid Dependence
POLICY STATEMENT Methadne Maintenance Treatment fr Opiid Dependence APPROVED BY COUNCIL: May 2010 PUBLICATION DATE: Dialgue, Issue 2, 2010 Disclaimer: As f May 19, 2018 physicians n lnger require an exemptin
More informationCommissioning Policy: South Warwickshire CCG (SWCCG)
Cmmissining Plicy: Suth Warwickshire CCG (SWCCG) Treatment Indicatin Criteria FreeStyle Libre Flash Cntinuus Glucse Mnitring System Type I Diabetes Prir apprval must be requested frm the Individual Funding
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 informationProstatitis - chronic - Management
Prstatitis - chrnic - Management Scenari: Diagnsis f chrnic prstatitis Hw shuld I diagnse chrnic prstatitis? Diagnse chrnic prstatitis if: The man has pain in the perineum r pelvic flr and lwer urinary
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 informationClinical Policy: Vedolizumab (Entyvio) Reference Number: ERX.SPA.163 Effective Date:
Clinical Plicy: Vedlizumab (Entyvi) Reference Number: ERX.SPA.163 Effective Date: 10.01.16 Last Review Date: 11.18 Revisin Lg See Imprtant Reminder at the end f this plicy fr imprtant regulatry and legal
More informationImmunotherapy Guide Increases Dosing Accuracy. Jared Darveaux, MD
Immuntherapy Guide Increases Dsing Accuracy Jared Darveaux, MD Disclsures Nne ON TARGET Backgrund Immuntherapy (IT) is a therapeutic tl used t treat allergic rhinitis and allergic asthma fr decades In
More informationImplementation of G6PD testing and radical cure in P. vivax endemic countries: considerations
Implementatin f G6PD testing and radical cure in P. vivax endemic cuntries: cnsideratins Malaria Plicy Advisry Cmmittee Geneva, Switzerland 16-18 September 2015 1 WHO Guidelines n Radical Cure WHO guidelines
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 informationImmunisation and Disease Prevention Policy
Immunisatin and Disease Preventin Plicy Quality Area 2: Children s Health and Safety 2.1 Each child s health is prmted 2.1.4 Steps are taken t cntrl the spread f infectius diseases and t manage injuries
More information