https://www.premera.com/medicalpolicies/5.01.646.pdf#search=policy
PHARMACY POLICY - 5.01.646 SGLT2 Inhibitors Effective Date: Jul. 1, 2025 Last Revised: ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.656.pdf#search=policy
PHARMACY POLICY - 5.01.656 Drug Quantity Management Effective Date: Oct. 1, 2025 Last ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/7.01.142.pdf#search=policy
MEDICAL POLICY - 7.01.142 Surgery for Groin Pain in Athletes BCBSA Ref. Policy: 7.01.142 Effective Date: May 1, 2025 Last Revised: Apr. 7, 2025 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/2.04.509.pdf#search=policy
MEDICAL POLICY - 2.04.509 Cardiovascular Risk Panels BCBSA Ref. Policy: 2.04.65 Effective Date: Dec. 1, 2025 Last Revised: Nov. 10, 2025 RELATED MEDICAL POLICIES: None Select a ...
https://www.premera.com/medicalpolicies/2.04.520.pdf#search=policy
MEDICAL POLICY - 2.04.520 Laboratory Testing Investigational Services BCBSA Ref. Policy: 2.04.159 Effective Date: Jan. 1, 2025 Last Revised: Nov. 1, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/5.01.545.pdf#search=policy
PHARMACY POLICY - 5.01.545 Pharmacologic Treatment of Benign Prostatic Hyperplasia ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.562.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.562 Imlygic (talimogene laherparepvec) Effective Date: ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.570.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.570 Pharmacologic Treatment of Duchenne Muscular Dystrophy BCBSA Ref. Policy: 5.01.27 & 5.01.46 Effective Date: Dec. 1, 2025* Last Revised: Nov. ...
https://www.premera.com/medicalpolicies/5.01.576.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.576 Drugs for Rare Diseases BCBSA Ref. Policy: 5.01.37 and 5.01.40 Effective Date: Nov. 1, 2025 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/5.01.581.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.581 Pharmacologic Treatment of Hemophilia BCBSA Ref. Policy: 8.01.65 Effective Date: Oct. 1, 2025 Last Revised: Sep. 9, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/5.01.589.pdf#search=policy
PHARMACY POLICY - 5.01.589 BRAF and MEK Inhibitors Effective Date: Nov. 1, 2025 Last ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.591_2026-02-06.pdf#search=policy
MEDICAL POLICY - 5.01.591 Immune Checkpoint Inhibitors Effective Date: Feb. 6, 2026* Last Revised: Nov. 11, 2025 Replaces: N/A *This policy has been revised. Click here to view the ...
https://www.premera.com/medicalpolicies/5.01.596.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.596 Pharmacologic Treatment of Osteoporosis Effective ... Medical Necessity criteria within this policy DOES NOT apply to Alaska fully- insured ...
https://www.premera.com/medicalpolicies/5.01.599.pdf#search=policy
PHARMACY POLICY - 5.01.599 Pharmacologic Treatment of Sleep Disorders Effective Date: ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/7.01.565.pdf#search=policy
MEDICAL POLICY - 7.01.565 Ablation of Peripheral Nerves to Treat Pain BCBSA Ref. Policy: 7.01.154 Effective Date: Dec. 1, 2025 Last Revised: Nov. 10, 2025 Replaces: 7.01.154 ...
https://www.premera.com/medicalpolicies/7.01.583.pdf#search=policy
MEDICAL POLICY - 7.01.583 Amniotic Membrane and Amniotic Fluid BCBSA Ref. Policy: 7.01.149 Effective Date: Jul. 1, 2025 Last Revised: Oct. 1, 2025 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/7.03.05.pdf#search=policy
MEDICAL POLICY - 7.03.05 Small Bowel, Liver and Multivisceral Transplant BCBSA Ref. Policy: 7.03.05 Effective Date: Dec. 1, 2025 Last Revised: Nov. 10, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/8.01.42.pdf#search=policy
MEDICAL POLICY - 8.01.42 Hematopoietic Cell Transplantation for Primary Amyloidosis BCBSA Ref. Policy: 8.01.42 Effective Date: Apr. 1, 2025 Last Revised: Mar. 10, 2025 Replaces: ...
https://www.premera.com/medicalpolicies/8.01.62.pdf#search=policy
MEDICAL POLICY - 8.01.62 Electronic Brachytherapy for Nonmelanoma Skin Cancer BCBSA Ref. Policy: 8.01.62 Effective Date: Oct. 1, 2025 Last Revised: Sep. 8, 2025 Replaces: N/A ...
https://www.premera.com/medicalpolicies/8.01.63.pdf#search=policy
MEDICAL POLICY - 8.01.63 Chimeric Antigen Receptor Therapy for Leukemia and Lymphoma BCBSA Ref. Policy: 8.01.63 Effective Date: Mar. 1, 2025 Last Revised: Jul. 1, 2025 Replaces: ...