The Medical Review staff of the Medical Management Department utilize clinical medical policies (CMPs) to guide decisions regarding Neighborhood’s Conditional Benefits.
Through collaboration with Neighborhood’s Associate Medical Director, and our specialty consultants, the policies are developed and/or revised following thorough review of current medical literature and standards of practice. To the extent possible, Neighborhood’s CMPs are developed according to evidence-based outcomes.
To view one of Neighborhood’s approved CMPs, please click the link below:
CMPs
- Acupuncture
- Adult Day Health
- Ambulance Transportation
- Assisted Living
- Bone Growth Stimulators
- Chiropractic Care
- Circulating Cell-free (ccfDNA)
- Cognitive Rehabilitation
- Continuous Glucose Monitoring
- Durable Medical Equipment (DME)
- Experimental Investigational
- External Beam/Teletherapy, Brachytherapy, IMRT, SBRT/SRS, IORT, and IGRT
- Fluoride Varnish
- Gender Affirmation
- Genetic Testing
- Genomic/Genetic/Biomarker/Tumor Marker Tests
- Hart Walker
- Hasbro Partial Program
- Home Care Services
- Infertility Services
- In Lieu of Services
- Levels of Care
- Neutron Beam and Proton Beam Radiation Therapy
- Non Standard Requests
- Obstetrical Ultrasound
- Out-of-Network & Out-of-Area
- Outpatient PT-OT Special Needs
- Outpatient Speech Special Needs
- Outpatient Rehab Therapies-Adult
- Pediatric Development and Autism Screening
- Phototherapy and Photochemotherapy for Dermatologic Conditions
- Plastic Surgery
- Private Duty-Extended Home Care-Skilled Hours
- Relizorb Enzyme Cartridge
- Specific IgE Testing
- Termination of Pregnancy
- Urine Toxicology Screening
- Vision Care
- Weight Management
Pharmacy Medical Benefit Policies
Pharmacy Medical Benefit Policies
- Actemra
- Aldurazyme
- Alpha1 Proteinase Inhibitor
- Amondys45
- Bal in Oil and Calcium EDTA
- Benlysta
- Beovu
- Berinert
- Botox
- Brineura
- Cerezyme/Elelyso/VPRIV
- Cimzia
- Cinacalcet
- Cinqair
- Cinryze
- Crysvita
- Duopa
- Durysta
- Dysport
- Elaprase
- Entyvio
- Erythropoiesis stimulating agents Non-Oncology: Epogen, Procrit, Aranesp, Mircera, Retacrit
- Evenity
- Evkeeza
- Exondys51
- Eylea
- Fabrazyme
- Fasenra
- General PA Policy
- Givlaari
- Haegarda
- Hemophilia Products – Anti-inhibitor Antibody
- Hemophilia Products-Anti-inhibitor Coagulant Complex
- Hemophilia Products – Factor IX
- Hemophilia Products- Factor VIIa
- Hemophilia Products- Factor VIII
- Hemophilia Products – Factor X
- Hemophilia Products – Factor XIII
- Hemophilia Products – Coagulation Factor XIII A-subunit
- Hemophilia Products – Factor VIII/VWF Complex
- Hemophilia Products – von Willebrand Factor (Vonvendi)
- H. P. Acthar
- Hyaluronic Acid Intraarticular Injections
- Ilaris
- Ilumya
- Immune Globulin – Intravenous Non-oncology
- Immune Globulin – Subcutaneous
- Infliximab/Remicade/Renflexis/Inflectra/Avsola
- Kalbitor
- Kanuma
- Krystexxa
- Lemtrada
- Long acting granulocyte colony stimulating factors non-oncology- Fulphila, Neulasta, Nyvepria, Udencya, and Zietenzo
- Lucentis
- Lumizyme
- Luxturna
- Medical Benefit Only Policy
- Medicaid and Commercial New to Market Policy
- Mepsevii
- Miacalcin
- Monoferric
- Myobloc
- Naglazyme
- Nexviazyme
- Nipent Non-Oncology
- Nucala
- Nulibry
- Ocrevus
- Oncology Hematology Policy
- Onpattro
- Orencia
- Oxlumo
- Parsabiv
- Prevymis
- Probuphine
- Radicava
- Revcovi
- Rituxan Non-Oncology
- Ruconest
- Ryplazim
- Saphnelo
- Scenesse
- Serostim
- Short-Acting Granulocyte Colony Stimulating Factors- Nivestym, Neupogen, Granix
- Signifor LAR
- Simponi Aria
- Soliris Non-Hematology Policy
- Somatuline Depot
- Spinraza
- Stelara
- Step Therapy Part B
- Step Therapy Medicaid and Commercial
- Strensiq
- Sublocade
- Susvimo
- Synagis
- Tepezza
- Testopel
- Tremfya
- Triptodur
- Trogarzo
- Tysabri
- Uplizna
- Vabysmo
- Viltepso
- Vimizim
- Vyepti
- Vyondys53
- Vyvgart
- Xenleta
- Xeomin
- Xiaflex
- Xolair
- Zolgensma
- Zulresso
Oncology/Hematology Pharmacy Medical Benefit Policies
- 5HT3 Receptor Antagonists: Zofran, Kytril, Anzemet, Aloxi, Akynzeo, Sancuso, Sustol
- Abecma
- Abraxane
- Adakveo
- Adcetris
- Alimta or Pemfexy
- Aliqopa
- Arranon
- Arzerra
- Asparlas
- Avastin and Biosimilars
- Azedra
- Bavencio
- Beleodaq
- Besponsa
- Besremi
- Blenrep
- Blincyto
- Bone Modifying Agents: Aredia, Zometa, Xgeva/Prolia
- Breyanzi
- Cablivi
- Carvykti
- Clolar
- Cosela
- Cyramza
- Danyelza
- Darzalex and Darzalex Faspro
- Doxil or Lipodox
- Elitek
- Elzonris
- Emend, Cinvanti and Varubi
- Empaveli
- Empliciti
- Enhertu
- Enjaymo
- Erbitux
- Erwinaze and Rylaze
- Erythropoiesis Stimulating Agents: Epogen, Procrit, Aranesp, Mircera, Retacrit
- Faslodex
- Folotyn
- Fusilev/Khapzory
- Fyarro
- Gamifant
- Gazyva
- Generic Drugs
- Halaven
- Imfinzi
- Imlygic
- Immune Globulin (IG) (IVIG, SCIG, IMIG)
- Iron Products: Infed, Venofer, Ferrlecit, Feraheme, Monferric, Injectafer
- Istodax
- Ixempra
- Jelmyto
- Jemperli
- Jevtana
- Kadcyla
- Keytruda
- Kimmtrak
- Kymriah
- Kyprolis
- LHRH Agonists and Antagonist: Lupron, Lupron Depot, Eligard, Viadur
- Libtayo
- Lumoxiti
- Lutathera
- Margenza
- Marqibo
- Monjuvi
- Myeloid Growth Factors: Neupogen, Granix, Leukine, Zarxio, Neulasta, Fulphila
- Mylotarg
- Nplate
- Oncaspar
- Onivyde
- Opdivo
- Padcev
- Photofrin
- Polivy
- Poteligeo
- Provenge
- Reblozyl
- Rituxan Products: Rituxan, Rituxan Hycela, Truxima, Ruxience
- Rybrevant
- Sarclisa
- Soliris
- Somatostatin Analog: Sandostatin SQ, LAR depot (Octreotide), and Somatuline (lanreotide)
- Step Therapy Medicare Part B Medications
- Step Therapy Medicaid and Commercial
- Sylvant
- Synribo
- Tecartus
- Tecentriq
- Tivdak
- Torisel
- Trastuzumab Products and Phesgo
- Treanda/Bendeka/Belrapzo
- Trisenox
- Trodelvy
- Ultomiris
- Unituxin
- Valstar
- Vectibix
- Voraxaze
- Vyxeos
- Xofigo
- Yervoy
- Yescarta
- Yondelis
- Zaltrap
- Zepzelca
- Zevalin
- Zynlonta