As part of our medical benefit management approach, we maintain disease-specific clinical guidance documents designed to promote evidence-based therapy utilization, alignment with FDA-approved indications, consideration of current clinical literature, and consistency with applicable Medicare coverage requirements. The information presented is intended to support providers in understanding applicable Medicare coverage requirements, current clinical evidence, FDA-approved labeling, and appropriate patient selection considerations.
For Medicare Fee-for-Service beneficiaries, coverage and payment determinations remain governed by applicable CMS requirements, including relevant LCDs and NCDs where applicable.
Clinical Guidance Documents
These documents summarize clinical evidence, FDA labeling, professional society recommendations, and common patient selection considerations associated with therapy use. They are intended to support clinical decision-making and care management activities.
- Alpha1-Proteinase Inhibitor UM Medical Policy
- Amyloidosis - Amvuttra UM Medical Policy
- Amyloidosis - Onpattro UM Medical Policy
- Amyloidosis - Tegsedi UM Medical Policy
- Bone Modifiers Denosumab (Xgeva) UM Policy
- Bone Modifiers Denosumab (Prolia)Policy
- CSF Pegfilgrastim Products UM Medical Policy
- CSF - Granix UM Medical Policy
- CSF - Ryzneuta UM Medical Policy
- CSF Filgrastim Products Medical Policy
- CSF- Rolvedon UM Medical Policy
- Dermatology - Gene Therapy - Zevaskyn UM Medical Policy
- Dermatology - Ycanth UM Medical Policy
- Enzyme Replacement Therapy - Elfabrio UM Medical Policy
- Enzyme Replacement Therapy - Fabrazyme UM Medical Policy
- GHP Medical Rebate Attestation - Rykindo 6.18.24
- Gaucher Disease - Enzyme Replacement Therapy - Cerezyme UM Medical Policy
- Gaucher Disease - Enzyme Replacement Therapy - Elelyso UM Medical Policy
- Gaucher Disease - Enzyme Replacement Therapy - Vpriv UM Medical Policy
- Gene Therapy - Vyjuvek UM Medical Policy
- Gonadotropin-Releasing Hormone Agonists - Central Precocious Puberty UM Medical Policy
- Gonadotropin-Releasing Hormone Agonists - Implants UM Medical Policy
- Gonadotropin-Releasing Hormone Agonists - Lupron Depot UM Medical Policy
- Hematology - Gene Therapy - Casgevy UM Medical Policy
- Hematology - Gene Therapy - Lyfgenia UM Medical Policy
- Hematology - Gene Therapy - Zynteglo UM Medical Policy
- Hemophilia - Altuviiio UM Medical Policy
- Hemophilia - Factor VIII Products UM Medical Policy
- Hemophilia - Gene Therapy - Hemgenix UM Medical Policy
- Hemophilia - Gene Therapy - Roctavian UM Medical Policy
- Hemophilia - Non-Factor Routine Prophylaxis Products - Hemlibra UM Medical Policy
- Hepatology - Givlaari UM Medical Policy
- Hepatology - Panhematin UM Medical Policy
- Hyaluronic Acid Derivatives (Intraarticular) UM Medical Policy
- Hyperlipidemia - PCSK9 Inhibitors - Leqvio UM Medical Policy
- Immune Globulin - Subcutaneous UM Medical Policy
- Immunologicals - Cinqair UM Medical Policy
- Immunologicals - Exdensur UM Medical Policy
- Immunologicals - Fasenra UM Medical Policy
- Immunologicals - Nucala UM Medical Policy
- Immunologicals - Tezspire UM Medical Policy
- Immunologicals - Xolair UM Medical Policy
- Inflammatory Conditions - Cimzia UM Medical Policy
- Inflammatory Conditions - Cosentyx Intravenous UM Medical Policy
- Inflammatory Conditions - Entyvio Intravenous UM Medical Policy
- Inflammatory Conditions - Ilaris UM Medical Policy
- Inflammatory Conditions - Ilumya UM Medical Policy
- Inflammatory Conditions - Infliximab Intravenous Products UM Medical Policy
- Inflammatory Conditions - Omvoh Intravenous UM Medical Policy
- Inflammatory Conditions - Orencia Intravenous UM Medical Policy
- Inflammatory Conditions - Simponi Aria UM Medical Policy
- Inflammatory Conditions - Skyrizi Intravenous UM Medical Policy
- Inflammatory Conditions - Tocilizumab Intravenous Products UM Medical Policy
- Inflammatory Conditions - Tremfya Intravenous UM Medical Policy
- Inflammatory Conditions - Ustekinumab Intravenous Products UM Medical Policy
- Iron Replacement - Ferumoxytol UM Medical Policy
- Iron Replacement - INFeD UM Medical Policy
- Iron Replacement - Injectafer UM Medical Policy
- Iron Replacement - Monoferric UM Medical Policy
- Medical Rebate Attestation - Rykindo 6.18.24
- Metabolic Disorders - Primary Hyperoxaluria - Oxlumo UM Medical Policy
- Metabolic Disorders - Primary Hyperoxaluria - Rivfloza UM Medical Policy
- Multiple Sclerosis (Injectable - CD20-Directed Cytolytic Antibody) - Briumvi UM Medical Policy
- Multiple Sclerosis (Injectable - CD20-Directed Cytolytic Antibody) - Ocrevus IV UM Medical Policy
- Multiple Sclerosis (Injectable - CD20-Directed Cytolytic Antibody) - Ocrevus Zunovo UM Medical Policy
- Multiple Sclerosis (Injectable - Other) - Lemtrada UM Medical Policy
- Multiple Sclerosis and Crohn_s Disease (Injectable - Other) - Natalizumab Products UM Medical Policy
- NCD 110.10_Iron Replacement - Iron Sucrose MA Policy 2.4.26
- NCD 110.10_Iron Replacement - Sodium Ferric Gluconate MA Policy 2.4.26
- NCD 110.21_ESA - Aranesp MA Policy 7.25.25
- NCD 110.21_ESA - Epoetin Alfa Products MA Policy 7.25.25
- NCD 110.24_Oncology (Injectable - CAR-T) - Aucatzyl MA Policy 12.3.25
- NCD 110.24_Oncology (Injectable - CART) - Breyanzi MA Policy 2.9.26
- NCD 110.24_Oncology (Injectable - CART) - Kymriah MA Policy 4.6.26
- NCD 110.24_Oncology (Injectable - CART) - Tecartus MA Policy 9.26.25
- NCD 110.24_Oncology (Injectable - CART) - Yescarta MA Policy 4.20.26
- Neurology - Gene Therapy - Lenmeldy UM Medical Policy
- Neurology - Imaavy UM Medical Policy
- Neurology - Rystiggo UM Medical Policy
- Neurology - Vyvgart Hytrulo UM Medical Policy
- Neurology - Vyvgart Intravenous UM Medical Policy
- Neurology Eculizumab Products Medical Policy
- Neurology PiaSky UM Medical Policy
- Neurology Ultomiris UM Medical Policy
- Noridian JE,JF_Botulinum Toxins - Botox MA Policy 6.23.26
- Noridian JE,JF_Botulinum Toxins - Daxxify MA Policy 6.23.26
- Noridian JE,JF_Botulinum Toxins - Dysport MA Policy 6.23.26
- Noridian JE,JF_Botulinum Toxins - Myobloc MA Policy 6.23.26
- Noridian JE,JF_Botulinum Toxins - Xeomin MA Policy 6.23.26
- Oncology (Injectable - CD20-Directed Antibody) - Rituxan Hycela UM Medical Policy
- Oncology (Injectable - HER2 Antagonist) - Herceptin Hylecta UM Medical Policy
- Oncology (Injectable - HER2 Antagonist) - Phesgo UM Medical Policy
- Oncology (Injectable - HER2 Antagonist) - Trastuzumab Products UM Medical Policy
- Oncology (Injectable - Programmed Death Receptor 1) - Keytruda Qlex UM Medical Policy
- Oncology (Injectable - Programmed Death Receptor-1) - Keytruda Intravenous UM Medical Policy
- Oncology (Injectable - Programmed Death Receptor-1) - Loqtorzi UM Medical Policy
- Oncology (Injectable - Programmed Death Receptor-1) - Opdivo Intravenous UM Medical Policy
- Oncology (Injectable - Programmed Death Receptor-1) - Opdivo Qvantig UM Medical Policy
- Oncology (Injectable) - Bevacizumab Products MA Policy 3.24.26 (2)
- Oncology (Injectable) - Bevacizumab Products UM Medical Policy
- Oncology (Injectable) - Gonadotropin-Releasing Hormone Analogs UM Medical Policy
- Oncology (Intravesical) - Adstiladrin UM Medical Policy
- Oncology (Intravesical) - Anktiva UM Medical Policy
- Oncology (Intravesical) - Inlexzo UM Medical Policy
- Oncology (Intravesical) - Valrubicin Products UM Medical Policy
- Ophthalmology - Gene Therapy - Encelto UM Medical Policy
- Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Aflibercept Products UM Medical Policy
- Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Beovu UM Medical Policy
- Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Ranibizumab Products UM Medical Policy
- Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Susvimo UM Medical Policy
- Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Vabysmo UM Medical Policy
- Repository Corticotropin - Acthar Gel UM Medical Policy
- Rituximab Intravenous Products UM Medical Policy
- Spinal Muscular Atrophy - Gene Therapy - Itvisma - UM Medical Policy
- Spinal Muscular Atrophy - Gene Therapy - Zolgensma - UM Medical Policy
- Spinal Muscular Atrophy - Spinraza UM Medical Policy
- Uplizna UM Medical Policy