Medical benefit pharmaceutical policies for providers
See the latest updates to our medical benefit pharmaceutical policies.
MBP 101.0 Zaltrap (ziv-aflibercept)
Zaltrap (ziv-aflibercept) acts as a soluble receptor that binds to human VEGF-A, to human VEGF-B), and to human PlGF. By binding to these endogenous ligands, ziv-aflibercept can inhibit the binding and activation of their cognate receptors. This inhibition can result in decreased neovascularization and decreased vascular permeability.
MBP 187.0 Zemdri (plazomicin)
Zemdri (plazomicin) is an aminoglycoside, which acts by binding to bacterial 30S ribosomal subunit, inhibiting protein synthesis.
New Policy 1/15/19
MBP 15.0 Zevalin (Ibritumomab tiuxetan (IDEC Y2B8))
ZevalinTM (ibritumomab tiuxetan) is the immunoconjugate resulting from a stable thiourea covalent bond between the monoclonal antibody ibritumomab and the linker-chelator tiuxetan. Zevalin binds specifically to the CD20 antigen (human B-lymphocyte-restricted differentiation antigen, Bp35) and prevents shedding from the cell surface and internalization upon antibody binding.
MBP 178.0 Zilretta (triamcinolone acetonide ER injection)
Zilretta (triamcinolone acetonide ER injection) is an extended-release intra-articular injection of triamcinolone that is indicated for the management of osteoarthritis pain of the knee. It is a long acting corticosteroid with minimal sodium-retaining potential. Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability.
New Policy 5/15/18
MBP 153.0 Zinplava (bezlotoxumab)
Zinplava (bezlotoxumab) is a human IgG1 monoclonal antibody that binds to C. difficile toxin B and neutralizes it to prevent its toxic effects; bezlotoxumab does not bind to C. difficile toxin A.
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