Clinical Policy: Experimental Technologies
Guidelines for evaluating coverage of technologies (drugs, procedures, devices, services, or supplies) that are or may be experimental or investigational when no other Centene policy applies; applies to health plans affiliated with Centene and governs provider requests for authorization and medical necessity determinations.
No material clinical or coverage changes in this revision.
Coverage Criteria and Determinations
Definition of experimental or investigational (I.A) and medical necessity requirements (I.B)
Coverage determinations consider BOTH of the following groups A and B:
Indication for regulatory approval need not match the requested indication.
B. Medical necessity considerations
- B.1: The most recent peer‑reviewed scientific studies do not conclude safety and effectiveness for the requested condition or are inconclusive.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.