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Sanford Health Plan

Policy Updates

The following policies have been updated.PR-10 Criteria for participating providers: Updates reflect certified professional midwives as a specialty that is not accepted by SHP. This policy is available online here.

Medical Policy Updates: effective March 1, 2017.

Mammoplasty: Sanford Health Plan no longer requires colored photos to be sent in for mammoplasty authorization requests.

Psychotropic medication metabolism testing: Sanford Health Plan, in conjunction with local experts in the field of Psychiatry and primarily assisted by the database from MCG (Milliman care guidelines) Policy A-0692 -will not cover testing of Psychotropic medication metabolism.

Pharmacy Policy Updates: Effective December 15, 2016.  To obtain a copy of these policies, contact our Pharmacy Management team at Pharmacy.Services@sanfordhealth.org

  • Actemra
  • Acthar Gel
  • Ampyra
  • Antidepressant Policy – remove second step for fetzima
  • Aubagio
  • Avonex
  • Betaseron
  • Cimzia
  • Contraceptive – update for Affordable Care Act compliance
  • Copaxone
  • Cosentyx
  • Enbrel
  • Entyvio
  • Epclusa
  • Extavia
  • Gilenya
  • Harvoni
  • Humira
  • Kineret
  • Lemtrada
  • Orencia
  • Otezla
  • Plegridy
  • Rebif
  • Remicade
  • Stelara
  • Taltz
  • Tecfidera
  • Tysabri
  • Weight Loss
  • Xeljanz and Xeljanz XR
  • Zepatier
  • Zinbryta
  • Zyvox

Retired Pharmacy Policies: Effective December 15, 2016. 

  • Accutane
  • Antiemetic
  • Compounds
  • Hep C (global policy)
  • Influenza treatments
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