Drug Policies and Coverage Determination Guidelines

MVP Health Care® has developed Drug Policies to assist us in administering health benefits. Our Drug Policies express MVP’s determination of whether a health service or drug is proven to be effective based on published clinical evidence. They are also used to decide whether a given health service is medically necessary. Services determined to be experimental, investigational, unproven, or not medically necessary by the clinical evidence are typically not covered. 

These policies are developed as needed, are regularly reviewed and updated, and are subject to change. These policies are provided for informational purposes and do not constitute medical advice. Treating physicians and health care providers are solely responsible for determining what care to provide their patients. Members should always consult their physician before making any decision about medical care. 

• Avastin Medicaid Policy (PDF)
• Duchenne Muscular Dystrophy Medicaid Policy (PDF)
• Herceptin Medicaid Policy (PDF)
• Perjeta Medicaid Policy (PDF)
• Xolair Medicaid Policy (PDF)