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
- Acthar Gel
- Antidepressant Policy – remove second step for fetzima
- Contraceptive – update for Affordable Care Act compliance
- Weight Loss
- Xeljanz and Xeljanz XR
Retired Pharmacy Policies: Effective December 15, 2016.
- Hep C (global policy)
- Influenza treatments