Medical benefit pharmaceutical policies for providers

See the latest updates to our medical benefit pharmaceutical policies. 

Choose a letter to view policies by first letter:

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

B

MBP 117.0 Beleodaq (belinostat) 
Beleodaq (belinostat) is a histone deacetylase inhibitor indicated for the treatment of patients with relapsed or refractory peripheral T-cell lymphoma (PTCL).
Reviewed 3/30/17

MBP 90.0 Benlysta (belimumab)
Benlysta (belimumab) is a B-Lymphocyte stimulator-specific (BLyS) inhibitor that blocks the binding of soluble BLyS, a B-cell survival factor, to its receptors on B cells which inhibits the survival of B-cells, including autoreactive B cells, and reduces the differentiation of b cells into immunoglobulin-producing plasma cells.
Reviewed 3/30/17

MBP 84.0 Berinert (C1 esterase inhibitor, human)
Berinert (C1 esterase inhibitor, human) is a plasma-derived C1 Esterase Inhibitor (Human) indicated for the treatment of acute abdominal,  facial , or laryngeal attacks of hereditary angioedema (HAE) in adult and adolescent patients. Berinert increases C1 inhibitor levels which play a role in the inflammatory process by inactivating it’s substrate by binding to the reactive site.
Reviewed 3/31/16

MBP 128.0 Blincyto (blinatumomab)
Blincyto (blinatumomab) is a bispecific CD19-directed CD3 T-cell engager indicated for the treatment of Philadelphia chromosome-negative relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL). This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.
Revised 11/15/16

MBP 42.0 Boniva (ibandronate sodium) Intravenous
Boniva (ibandronate sodium) is a nitrogen-containing bisphosphonate that inhibits osteoclast-mediated bone resorption.
Reviewed 1/31/17

MBP 11.0 Botulinum Toxin and Derivatives (Botox, Dysport, Myobloc, Xeomin)
Botulinum Toxin injections are used to treat various focal muscle spastic disorders. They produce presynaptic neuromuscular blockade by preventing the release of acetylcholine from the nerve endings. The resulting chemical denervation of muscle produces local paralysis and allows individual muscles to be weakened selectively.
Revised 11/15/16

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