Provider Quick Alert

June 1, 2020
Review all  Medical Coverage Policies at QualChoice.com.
New and Amended Medical Policies

P = Payment Change
C = Code Change
V = Verbiage Change

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI038   V
Genetic Testing 01/01/20 Added indications for F1CDx panel.
BI217   C
Orthotics Devices & Orthotic Services
01/01/20
Updated codes.
BI553   C
Knee Braces 01/01/20 Updated codes.
BI299   V
Bevacizumab
05/01/20
Clarified that all products, brand and biosimilars, require pre-authorization.
BI585   V
Calcitonin Gene Related Peptide (CGRP) Inhibitors 06/01/20 Updated to include coverage criteria for oral CGRP inhibitors (Ubrelvy and Nurtec) and IV Vyepti.
BI653  New
Tazverik
06/01/20
Used to treat epithelioid sarcoma; requires pre-authorization. Oral specialty drug; must be obtained through a contracted specialty pharmacy.
BI654  New
Ayvakit (avapritinib)
06/01/20
Used to treat gastrointestinal stromal tumors (GIST); requires pre-authorization. Oral specialty drug; must be obtained through a contracted specialty pharmacy.
BI655  New
Sarclisa 06/01/20 Used to treat multiple myeloma when other treatments have failed. Requires pre-authorization. Considered a specialty drug; covered under the medical benefit.
Comi ng Amendments

Medical Policy Number
Medical Policy Name Effective Date of Change Description of Changes
BI448 V
Preventive Care Medications 07/01/20 Updated PrEP medications, breast cancer prophylaxis coverage, tobacco cessation and aspirin. Deleted iron supplementation as it is no longer a USPSTF A or B recommendation.
BI506  V
Nucala 07/01/20 Updated to require dated lab report of elevated eosinophil count.
For questions about QualChoice Medical Coverage Policies, please contact your Provider Relations Representative 
at 800.235.7111 or 501.228.7111, ext. 7004, Monday through Friday, 8:00 a.m. to 5:00 p.m.

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