The pharmacy policies you are about to view are the property of Blue Cross and Blue Shield of Nebraska for Prime Therapeutics (Prime). They have been developed by the Medical Policy Committee (Committee) for use by Prime in determining the scientific validity of new and existing medical technologies, treatments, devices, drugs, etc. The Pharmacy Policies are used in administering plan benefits and do not constitute medical advice. Physicians and other health care providers are responsible for providing medical advice and treatment. The Committee reviews new technologies as they emerge as well as existing Policies on a regular basis; therefore, these Policies are subject to change without notice. These Pharmacy Policies do not constitute authorization, certification or a contract for benefits. Benefits for a particular service or treatment are determined by the terms and conditions of the applicable benefit contract.
These policies reference CPT codes. Current Procedural Terminology (CPT) is copyright 2003 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
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