Medical Drug Policies

Viva Health will utilize consistent resources/criteria for Part B organizational determinations. CMS NCDs and LCDs supersede all other criteria; health plans are allowed to utilize other criteria/policies only in the absence of CMS coverage policies. For requests in which there are no fully established CMS NCDs or LCDs which apply, the following sources will be referenced and utilized as appropriate:

  • National Comprehensive Cancer Network (for oncology drug requests)
  • CMS Approved Compendia
  • Internal medical drug policies
  • FDA approved prescribing information