Choice Medicare Specific Medical Policies - Current

NCD 110.10_Iron Replacement – Iron Sucrose MA Policy 2.4.26
NCD 110.10_Iron Replacement – Sodium Ferric Gluc 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
Noridian JE,JF_Botulinum Toxins – Botox MA Policy 4.2.26
Noridian JE,JF_Botulinum Toxins – Daxxify MA Policy 4.2.26
Noridian JE,JF_Botulinum Toxins – Dysport MA Policy 4.2.26
Noridian JE,JF_Botulinum Toxins – Myobloc MA Policy 4.2.26
Noridian JE,JF_Botulinum Toxins – Xeomin MA Policy 4.2.26
Noridian JE,JF_Immune Globulin – Intravenous MA Policy 4.17.26
Oncology (Injectable) – Bevacizumab Products MA Policy 3.24.26 (2)

Choice Commercial Medical Policies - Current

Alpha1-Proteinase Inhibitor

Alpha1-Proteinase Inhibitor Products UM Medical Policy

Amyloidosis

Amyloidosis – Amvuttra UM Medical Policy
Amyloidosis – Onpattro UM Medical Policy
Amyloidosis – Tegsedi UM Medical Policy

Bone Modifiers

Bone Modifiers – Denosumab Products (Prolia) UM Medical Policy
Bone Modifiers – Denosumab Products (Xgeva) UM Medical Policy

Botulinum Toxins

Botulinum Toxins – Botox UM Medical Policy
Botulinum Toxins – Daxxify UM Medical Policy
Botulinum Toxins – Dysport UM Medical Policy
Botulinum Toxins – Myobloc UM Medical Policy
Botulinum Toxins – Xeomin UM Medical Policy

Colony Stimulating Factors

Colony Stimulating Factors – Filgrastim Products UM Medical Policy
Colony Stimulating Factors – Granix UM Medical Policy
Colony Stimulating Factors – Pegfilgrastim Products UM Medical Policy
Colony Stimulating Factors – Rolvedon UM Medical Policy
Colony Stimulating Factors – Ryzneuta UM Medical Policy

Complement Inhibitors

Complement Inhibitors Eculizumab Products UM Medical Policy
Complement Inhibitors PiaSky UM Medical Policy
Complement Inhibitors Ultomiris UM Medical Policy

Dermatology

Dermatology – Gene Therapy – Vyjuvek UM Medical Policy
Dermatology – Gene Therapy – Zevaskyn UM Medical Policy
Dermatology – Ycanth UM Medical Policy

Enzyme Replacement Therapy

Enzyme Replacement Therapy – Elfabrio UM Medical Policy
Enzyme Replacement Therapy – Fabrazyme UM Medical Policy

Erythropoiesis-Stimulating Agents

Erythropoiesis-Stimulating Agents Epoetin Alfa Products UM Medical Policy
Erythropoiesis-Stimulating Agents – Aranesp UM Medical Policy

Gaucher Disease

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

Gonadotropin

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

Hematology – Gene Therapy – Casgevy UM Medical Policy
Hematology – Gene Therapy – Lyfgenia UM Medical Policy
Hematology – Gene Therapy – Zynteglo UM Medical Policy

Hemophilia

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
Hemophilia – Non-Factor Routine Prophylaxis Products Hympavzi PA Policy_deidentified

Immunologicals

Immunologicals – Fasenra UM Medical Policy
Immunologicals – Nucala UM Medical Policy
Immunologicals – Tezspire UM Medical Policy

Inflammatory Conditions

Inflammatory Conditions – Cimzia UM Medical Policy
Inflammatory Conditions – Cosentyx Intravenous UM Medical Policy
Inflammatory Conditions – Entyvio Intravenous UM Medical Policy
Inflammatory Conditions – Etanercept Products PA Policy_deidentified
Inflammatory Conditions – Ilaris UM Medical Policy
Inflammatory Conditions – Ilumya UM Medical Policy
Inflammatory Conditions – Infliximab IV 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 IV Products UM Medical Policy
Inflammatory Conditions – Tocilizumab SubQ Products PA Policy_deidentified
Inflammatory Conditions – Tremfya Intravenous UM Medical Policy
Inflammatory Conditions – Tremfya Subcutaneous PA Policy_deidentified
Inflammatory Conditions – Ustekinumab IV Products UM Medical Policy
Inflammatory Conditions – Ustekinumab SubQ Products PA Policy with Dosing_deidentified
Inflammatory Conditions – Zymfentra PA Policy_deidentified

Oncology

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 IV UM Medical Policy
Oncology (Injectable – Programmed Death Receptor-1) – Keytruda Qlex UM Medical Policy
Oncology (Injectable – Programmed Death Receptor-1) – Loqtorzi UM Medical Policy
Oncology (Injectable – Programmed Death Receptor-1) – Opdivo IV UM Medical Policy
Oncology (Injectable – Programmed Death Receptor-1) – Opdivo Qvantig UM Medical Policy
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

Ophthalmology – Gene Therapy – Encelto UM Medical Policy
Ophthalmology – VEGF Inhibitors – Aflibercept Products UM Medical Policy
Ophthalmology – VEGF Inhibitors – Beovu UM Medical Policy
Ophthalmology – VEGF Inhibitors – Ranibizumab Products UM Medical Policy
Ophthalmology – VEGF Inhibitors – Susvimo UM Medical Policy
Ophthalmology – VEGF Inhibitors – Vabysmo UM Medical Policy

Repository Corticotropin

Repository Corticotropin – Acthar Gel UM Medical Policy

Rituximab

Rituximab Intravenous Products UM Medical Policy

Spinal Muscular Atrophy

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

Uplizna UM Medical Policy