https://www.premera.com/medicalpolicies/5.01.549.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.549 Off-Label Use of Drugs and Biologic Agents Effective ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ ...
https://www.premera.com/medicalpolicies/5.01.576_2026-07-02.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: Jul. 2, 2026* Last Revised: Mar. 10, 2026 Replaces: N/A *View ...
https://www.premera.com/medicalpolicies/5.01.588.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.588 Pharmacologic Prevention and Treatment of HIV/AIDS ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ ...
https://www.premera.com/medicalpolicies/5.01.593_2026-07-02.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.593 Pharmacologic Treatment of Transthyretin-Mediated Amyloidosis BCBSA Ref. Policy: 5.01.30 Effective Date: Jul. 2, 2026* Last Revised: Mar. 10, ...
https://www.premera.com/medicalpolicies/5.01.629.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.629 Pharmacologic Treatment of Psoriasis Effective Date: ... Medical Necessity criteria within this policy DOES NOT apply to Alaska fully- insured ...
https://www.premera.com/medicalpolicies/5.01.632.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.632 Pharmacologic Treatment of Bladder Cancer Effective ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.643.pdf#search=policy
MEDICAL POLICY - 5.01.643 Prescription Digital Therapeutics for Substance Use Disorders BCBSA Ref. Policy: 5.01.35 Effective Date: Nov. 1, 2025 Last Revised: Apr. 1, 2026 ...
https://www.premera.com/medicalpolicies/5.01.653.pdf#search=policy
MEDICAL POLICY - 5.01.653 Miscellaneous Intravitreal Drugs Effective Date: Apr. 1, 2026 ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/7.01.144.pdf#search=policy
MEDICAL POLICY - 7.01.144 Patient-Specific Instrumentation (e.g., Cutting Guides) for Joint Arthroplasty BCBSA Ref. Policy: 7.01.144 Effective Date: Nov. 1, 2025 Last Revised: ...
https://www.premera.com/medicalpolicies/7.01.175.pdf#search=policy
MEDICAL POLICY - 7.01.175 Temporarily Implanted Nitinol Device (iTind) for Benign Prostatic Hyperplasia BCBSA Ref. Policy: 7.01.175 Effective Date: Mar. 1, 2026 Last Revised: Feb. ...
https://www.premera.com/medicalpolicies/7.01.563.pdf#search=policy
MEDICAL POLICY - 7.01.563 Ablative Treatments for Occipital Neuralgia, Chronic Headaches, ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/7.01.594.pdf#search=policy
MEDICAL POLICY - 7.01.594 Percutaneous Revascularization Procedures for Lower Extremity Peripheral Arterial Disease BCBSA Ref. Policy: 7.01.178 Effective Date: Jan. 1, 2026 Last ...
https://www.premera.com/medicalpolicies/7.01.604.pdf#search=policy
MEDICAL POLICY - 7.01.604 Gastroesophageal Reflux Surgery in Adults BCBSA Ref. Policy: Not Applicable Effective Date: Feb. 6, 2026 Last Revised: Feb. 18, 2026 Replaces: N/A ...
https://www.premera.com/medicalpolicies/7.01.605.pdf#search=policy
MEDICAL POLICY - 7.01.605 Shoulder Arthrotomy in Adults Effective Date: Mar. 4, 2026 Last ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/7.01.607.pdf#search=policy
MEDICAL POLICY - 7.01.607 Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions BCBSA Ref. Policy: 7.01.78 Effective Date: Nov. 7, 2025 Last Revised: ...
https://www.premera.com/medicalpolicies/8.01.11.pdf#search=policy
MEDICAL POLICY - 8.01.11 Transcatheter Arterial Chemoembolization (TACE) to Treat Primary or Metastatic Liver Malignancies BCBSA Ref. Policy: 8.01.11 Effective Date: Nov. 1, 2025 ...
https://www.premera.com/medicalpolicies/9.03.508.pdf#search=policy
MEDICAL POLICY - 9.03.508 Orthoptic Training for the Treatment of Vision or Learning ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/1.01.537.pdf#search=policy
MEDICAL POLICY - 1.01.537 Low Intensity Pulsed Ultrasound Fracture Healing Device BCBSA Ref. Policy: 1.01.05 Effective Date: Jul. 1, 2025 Last Revised: Jun. 23, 2025 Replaces: ...
https://www.premera.com/medicalpolicies/2.04.123.pdf#search=policy
MEDICAL POLICY - 2.04.123 Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases BCBSA Ref. Policy: 2.04.123 Effective Date: Sep. 1, ...
https://www.premera.com/medicalpolicies/2.04.514.pdf#search=policy
MEDICAL POLICY - 2.04.514 Protein Biomarkers for Diagnosis and Risk Assessment of Prostate Cancer BCBSA Ref. Policy: 2.04.33 Effective Date: Jan. 1, 2026 Last Revised: Dec. 9, ...