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TUFTS HEALTH PLAN TO STOP COVERAGE OR TRIPLE COPAYMENTS FOR SOME DRUGSAlex Pham
s Utilization Management Program includes the evaluation of requests for coverage by determining the medical necessity, appropriateness and efficiency of the health care services under the applicable health benefit plan. Utilization management services will be provided where licensed or permissible under ...
s blood pressure during a 24-hour cycle. The ordering physician then reviews these measurements. Cover age Gui del i nes Tufts Health Plan may authorize the coverage of ambulatory blood pressure monitoring for those members with suspected white coat hypertension. White coat hypertension is defined ...
For self-insured plans, drug coverage may vary depending on the terms of the benefit document. If a discrepancy exists between a coverage guideline and a self-insured Member's benefit document, the provisions of the benefit document will govern. Applicable state or federal mandates will take ...
Added note regarding submission of X DEA number. October 9, 2012: Removed requirement of participation in psychosocial support and adherence to treatment plan from Induction Therapy coverage guidelines August 6, 2013: No changes August 12, 2014: No changes.RX/MED...
Subsequent endorsement date(s) and changes made: November 2001: Renewed, no changes made November 2001: Renewed, no changes made May 2002: Renewed, removed coverage for all short bones, except the scaphoid bone of the wrist, when the criteria is met, redefined long bone criteria...
Pharmacy Medical Necessity Guidelines: Seroquel® (quetiapine) 25 mg and 50 mg tablets February 12, 2013: Added Psychiatric Mental Health Nurse Practitioner as a provider that can prescribe Seroquel to the Pharmacy Coverage guidelines June 11, 2013: Removed the language requiring diagnosis ...
APPROVAL HISTORY January 11, 2011: Reviewed by the Pharmacy and Therapeutics Committee January 10, 2012: No changes October 9, 2012: Effective January 1, 2013, coverage of Gilenya (fingolimod) requires documented failure,contraindication, or intolerance to at least one injectable ...