January 2018 Medical Policy & Pharmacy Policy Updates
Medical Coverage Policy
- Breast Reconstruction Following Mastectomy or Lumpectomy – (0178)
- Genetic Testing for Heritable and Multifactorial Conditions – (0052)
- Genetic Testing for Hereditary Cardiomyopathies and Arrhythmias – (0517)
- Genetic Testing for Reproductive Carrier Screening and Prenatal Diagnosis – (0514)
- Tumor Profiling, Gene Expression Assays and Molecular Diagnostic Testing for Hematology/Oncology Indications – (0520)
- Genetic Testing for Hereditary Cancer Susceptibility Syndromes – (0518)
- High Intensity Focused Ultrasound (HIFU) – (0274)
- Home Blood Glucose Monitors – (0106)
- Hospital Beds and Accessories – (0273)
- Tissue-Engineered Skin Substitutes – (0068)
Pharmacy (Drugs & Biologics) Policies
- Edaravone – (1806)
- Step Therapy – Standard Prescription Drug Lists (Employer Group Plans) – (1801)
- Step Therapy – Value Prescription Drug Lists (Employer Group Plans) – (1802)
- Step Therapy – Legacy Prescription Drug Lists (Employer Group Plans) – (1803)
- Botulinum Therapy – (1106)
- Oral Phosphodiesterase-5 (PDE5) Inhibitors – (7003)
- PCSK9 Inhibitors – (1509)
- Somatropin – (4012)
- Vascular Endothelial Growth Factor (VEGF) Inhibitors for Ocular Use – (1206)
Policy Alerts monitors Commercial and Medicare medical policies for changes. While Payers typically update medical policies annually, there are many reasons why a Payer might review or update a policy. When reviews occur out of cycle, they may go unnoticed. Policy Alerts keeps you informed of upcoming and unexpected coverage changes affecting your product. Quickly understanding the changes Payers make can help you adjust reimbursement strategies impacting your business.
Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on Payer decisions in real-time. Whenever changes occur, email notifications containing a summary of those changes are delivered to your inbox. Clients can access detailed coverage reports and medical policies on the interactive Dashboard portal. Save time and keep focused on the important Payer medical policy reviews and coverage decisions affecting your product!
Policy Alerts takes a client-focused hands-on approach and works hard to provide our customers with helpful insights and actionable analytics over raw data. We understand what our clients need and we are dedicated to making sure we provide timely, accurate and always up-to-date reports that can be used to implement and support a successful reimbursement strategy.
Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.