Human Growth Hormone Page 1 of 60
Human Growth Hormone Page 1 of 60 Medical Policy Title: Human Growth Hormone Prior Authorization IS REQUIRED by the Member’s Contract Prior Authorization Form: BCBSKS reviews the Prior Authorization requests http://www.bcbsks.com/CustomerService/Forms/pdf/15-811_Growth_Hormone_PA.pdf Link to Drug List (Formulary): http://www.bcbsks.com/drugs/ Professional Institutional Original Effective Date: February 4, 1986 Original Effective Date: August 18, 2008 Revision Date(s): January 30, 2014; Revision Date(s): January 30, 2014; December 9, 2014; June 23, 2015; December 9, 2014; June 23, 2015; December 8, 2015; January 1, 2017; December 8, 2015; January 1, 2017; May 24, 2017; August 18, 2017; May 24, 2017; August 18, 2017; December 20, 2017; December 5, 2018; December 20, 2017; December 5, 2018; October 1, 2019; January 1, 2020; October 1 2019; January 1, 2020; October 1, 2020 October 1, 2020 Current Effective Date: January 1, 2020 Current Effective Date: January 1, 2020 State and Federal mandates and health plan member contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. To verify a member's benefits, contact Blue Cross and Blue Shield of Kansas Customer Service. The BCBSKS Medical Policies contained herein are for informational purposes and apply only to members who have health insurance through BCBSKS or who are covered by a self-insured group plan administered by BCBSKS. Medical Policy for FEP members is subject to FEP medical policy which may differ from BCBSKS Medical Policy. The medical policies do not constitute medical advice or medical care.
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