Medical benefit pharmaceutical policies for providers
See the latest updates to our medical benefit pharmaceutical policies.
MBP 266.0 Jelmyto (mitomycin ureteral gel)
Mitomycin alkylates DNA to produce DNA cross-linking (primarily with guanine and cytosine pairs) and inhibits DNA and RNA synthesis. Mitomycin is not cell cycle specific but has its maximum effect against cells in late G and early S phase. Following instillation into the pyelocalyceal system, mitomycin (ureteral gel) forms a semisolid gel that dissolves from normal kidney urine flow, releasing mitomycin.
New Policy 9/20/22
MBP 236.0 Jemperli (dostarlimab-gxly)
Jemperli is an anti-PD-1 humanized IgG4 monoclonal antibody which inhibits programmed cell death-1 (PD-1) activity by binding to the PD-1 receptor on T-cells to block PD-1 ligands (PD-L1 and PD-L2) from binding. Blocking the PD-1 pathway inhibits the negative immune regulation caused by PD-1 receptor signaling
MBP 82.0 Jevtana (cabazitaxel)
Jevtana (cabazitaxel) is a microtubule inhibitor indicated in combination with prednisone for treatment of patients with hormone-refractory metastatic prostate cancer previously treated with a docetaxel-containing treatment regimen.
Learn more about Geisinger Health Plan.
Log in to NaviNet to access and view prior authorization information.
Clinical guidelines offer providers consistent and appropriate guidance for diagnosis and treatment of specific conditions or diseases.
Terms and conditions
View GHP’s terms and conditions.
Questions? Contact us
If you have questions or need more information, contact Geisinger Health Plan.