Supplemental Plans (more on this next) Medicare Cost Plans Medicare Medical Savings Account Plans Private Fee-for-Service Plans Now, when it comes to Medicare’s Part D coverage, there are four drug coverage phases you’ll need to learn: 1. Deductible As with normal insurance, you must fork...
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...
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 services that are proven safe and effective where those indications are not f...
Aetna plans exclude coverage of cosmetic surgery and procedures that are not medically necessary, but generally provide coverage when the surgery or procedure is needed to improve the functioning of a body part or otherwise medically necessary even if the surgery or procedure also improves or changes...
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 ...
This Clinical Policy Bulletin addresses the following tocilizumab products for commercial medical plans. For Medicare criteria, see Medicare Part B Criteria.tocilizumab (Actemra) tocilizumab-aazq (Tyenne) tocilizumab-bavi (Tofidence)Note: Requires Precertification:...
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...
For Medicare Part B plans, call (866) 503-0857 or fax (844) 268-7263.Hepatitis B Immune GlobulinCriteria for Initial Approval Aetna considers hepatitis B immune globulin medically necessary for members who have had contact with an individual diagnosed with hepatitis B virus (HBV). Risk groups ...
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...
plans to submit data outcomes from a clinical trial that was completed in April 2022 for publication in April 2023, and to the FDA for consideration of market authorization in May 2023. The goal for commercial launch is set for late 2023 (TecTraum, 2022a). Therapeutic Hypothermia for the ...