Clinical Coverage Policy Update

The following new or amended clinical coverage policies are available on NC Medicaid’s website:

• 1B, Physician’s Drug Program (PDP) – Oct. 1, 2019
• 1B-1, Botulinum Toxin Treatment: Serotype A (Botox, Dysport & Xeomin) Serotype B (Myobloc) (Termination) – Oct. 1, 2019
• 1B-2, Rituximab (Rituxan) (Termination) – Oct. 1, 2019
• 1B-3, Intravenous Iron Therapy (Termination) – Oct. 1, 2019
• 3K-2, Community Alternatives Program for Disabled Adults (CAP/DA) – Oct. 1, 2019
• 3D, Hospice Services - Oct. 1, 2019
• 5A-3, Nursing Equipment & Supplies - Oct. 1, 2019
• 9C,  Mental Health Drug Management (Termination)  - Oct. 1, 2019
• 11A-1, HSCT for Acute Lymphoblastic Leukemia (ALL) – Oct. 1, 2019
• 11A-2, HSCT for Acute Myeloid Leukemia (AML)  - Oct. 1, 2019
• 11A-3, HSCT for Chronic Myeloid Leukemia (CML) - Oct. 1, 2019
• 11A-5, Allogeneic HSCT for Genetic Diseases & Acquired Anemias - Oct. 1, 2019
• 11A-6, HSCT in the Treatment of Germ Cell Tumors - Oct. 1, 2019
• 11A-7, HSCT for Hodgkin Lymphoma - Oct. 1, 2019
• 11A-8, HSCT for Multiple Myeloma, POEMS, & Primary Amyloidosis - Oct. 1, 2019
• 11A-9, Allogeneic HSCT for Myelodysplastic Syndromes & Myeloproliferative Neoplasms - Oct. 1, 2019
• 11A-11, Hematopoietic Stem-Cell Transplantation for Non-Hodgkin Lymphomas – Oct. 1, 2019
• 11A-14, Placental and Umbilical Cord Blood as a Source of Stem Cells - Oct. 1, 2019
• 11A-16, HSCT for Chronic Lymphocytic Leukemia (CLL) & Small Lymphocytic Lymphoma (SLL) – Oct. 1, 2019
• 11A-17, CAR-T Cell Therapy - Oct. 1, 2019

These policies supersede previously published policies and procedures.

Proposed new or amended Medicaid and NC Health Choice clinical coverage policies are posted for comment throughout the month. Visit Proposed Medicaid and NC Health Choice Policies for current posted policies and instructions to submit a comment.