ND Committee Review
Internal Medical Policy Committee 11-23-2021 -
Effective January 1, 2022
- Adopted Medicaid Expansion specific policy
Internal Medical Policy Committee 11-29-2022 -
Effective January 1, 2023
- Updated
initial criteria,
and
- Updated
experimental/investigational statement
Internal Medical Policy Committee 5-23-2023 -
Effective April 7, 2023
- Updated
policy to make Makena (hydroxyprogesterone caproate) always experimental/investigational due to the FDA withdrawal of approval of Makena which occurred on April 6, 2023.
- Removed
J1729 from the criteria
- Added
Note concerning J1729
Internal Medical Policy Committee 1-16-2024 -
Effective March 01, 2024
- Added
note: All products under J1729 became inactive as of November 29, 2023
- Added
diagnosis codes for J1729 for any supply that is being depleted
Internal Medical Policy Committee 10-14-2025
Effective February 28, 2025