Medical benefit pharmaceutical policies for providers
See the latest updates to our medical benefit pharmaceutical policies.
MBP 5.0 Remicade (infliximab) or Inflectra (infliximab-dyyb)
Infliximab is a therapeutic agent that inhibits activity of tumor necrosis factor alpha (TNF-alpha), a biological response mediator of inflammation. TNF-alpha is a key inflammatory mediator in rheumatoid arthritis, Crohn’s disease and other autoimmune disorders. In these chronic conditions, overproduction of TNF-alpha leads to inflammation. Infliximab reduces inflammation by binding to and neutralizing TNF- alpha on the cell membrane and in the blood.
MBP 62.0 Remodulin IV (treprostinil sodium)
Remodulin IV (treprostinil sodium) is a type of medication called a prostaglandin analog which helps the body open blood vessels located within pulmonary and systemic vascular beds.
MBP 48.0 Rituxan (rituximab)
Rituxan (rituximab) is a genetically engineered chimeric murine/human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes. Rituximab has been shown to be effective in rheumatoid arthritis in three randomized controlled trials and is now FDA-approved for use in combination with methotrexate (MTX) for reducing signs and symptoms in adult patients with moderately- to severely-active rheumatoid arthritis (RA) who have had an inadequate response to one or more tumor necrosis factor (TNF) antagonist therapies.
MBP 124.0 Ruconest (C1 esterase inhibitor, recombinant)
Ruconest (C1 esterase inhibitor, recombinant) is indicated for the treatment of acute hereditary angioedema (HAE) attacks in adults and adolescent patients. Ruconest is a recombinant C1 esterase inhibitor (rhC1INH) which irreversibly binds target proteases (activated C1s, kallikrein, factor XIIa, and factor XIa) of the contact and complement systems.
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Clinical guidelines offer providers consistent and appropriate guidance for diagnosis and treatment of specific conditions or diseases.
Terms and conditions
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