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Content with Policies & Guidelines Final Provider-Administered Drug Precertification Policies .
Durolane, Euflexxa, Gel-One, GelSyn-3, GenVisc 850, Hyalgan, Hymovis, Monovisc, Orthovisc, Supartz/Supartz FX, Synojoynt, Synvisc, Synvisc-One, TriVisc, VISCO-3, Triluron, sodium hyaluronate 1%
Alyglo, Bivigam, Flebogamma, Gamunex-C, Gammagard Liquid, Gammagard S/D, Gammaked, Gammaplex, Octagam, Privigen, Panzyga
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Macugen® (pegaptanib)
Policy Number: PH-0081
Intravitreal
Last Review Date:...