In December 2022, the FDA approved Actemra intravenous administration for the treatment of COVID-19 in hospitalized adults who are receiving systemic corticosteroids and require supplemental oxygen, noninvasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). FDA approval wa...
This Clinical Policy Bulletin addresses gonadotropin-releasing hormone analogs and antagonists for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: For the prostate cancer indication only, precertification of gonadotropin-releasing hormone products (...
pharmacy benefit manager — CVS Caremark, serving about 93 million members — plus CVS Specialty, one of the nation’s biggest specialty pharmacies, and a leading stand-alone Medicare Part D prescription drug plan. Serving about 39 million people, Aetna brings to the table a diverse range of ...
Aetna's policy on parenteral and enteral nutrition is similar to Medicare policy. Medicare provides reimbursement under the part-B prosthetic-device benefit for parenteral and enteral nutrition. Consistent with its policy of covering supplies necessary for use of prosthetics, Medicare will generally cover...
Precertification of immune globulin human intramuscular injection (IGIM) (GamaSTAN) is required of all Aetna participating providers and members in applicable plan designs. For precertification of immune globulin human intramuscular injection (IGIM) (GamaSTAN), call (866) 752-7021 (commercial) or ...
Note: Except for Medicare plans and where coverage is mandated by state law, generally coverage for diabetic supplies would be provided under a pharmacy rider and not as part of medical coverage. Certain diabetic supplies may also be covered under the medical plan if no pharmacy or diabetic supp...
This Clinical Policy Bulletin (CPB) supplements but does not replace, modify, or supersede existing Medicare Regulations or applicable National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs). The supplemental medical necessity criteria in this CPB further define those indications for...
This Clinical Policy Bulletin addresses vascular endothelial growth factor inhibitors for ocular indications for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of aflibercept [(Eylea), (Eylea HD)], aflibercept-jbvf (Yesafili...
Since surgery to correct a condition of "moon face" which developed as a side effect of cortisone therapy does not meet the exception to the exclusion, it is not covered under Medicare (§1862(a)(10) of the Act). An UpToDate review on “Overview of breast disorders in children and ...
Policy Scope of Policy This Clinical Policy Bulletin addresses growth hormone (GH) and growth hormone antagonists for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of Somavert is required of all Aetna participating providers...