Community-Care policy updates
Track new and updated Community-Care policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Lumizyme (alglucosidase alfa) — Medical Benefit Medication Utilization Policy | Community-Care | Clinical | Pharmacy & Specialty Drugs | Modified | Apr 1, 2024 |
| Sylvant | Community-Care | Clinical | Hematology/Oncology | Modified | Sep 1, 2022 |
| Medical Benefit Medication Utilization Policy — sebelipase alfa (LAL deficiency) coverage criteria | Community-Care | Clinical | Endocrinology | Modified | Jun 1, 2022 |
| Unspecified Community-Care policy | Community-Care | Administrative | Psychiatry/Behavioral Health | Modified | — |
| Authorization Request / Prior Authorization Submission | Community-Care | Administrative | — | Modified | — |
| Benralizumab (medical benefit) coverage — criteria for severe/eosinophilic asthma and EGPA | Community-Care | Clinical | Allergy/Clinical Immunology | Modified | — |
| Ecallantide (J1290) for Acute Hereditary Angioedema — Coverage Criteria | Community-Care | Clinical | Allergy/Clinical Immunology | Modified | — |
| Mepolizumab (medical benefit) utilization — coverage criteria | Community-Care | Clinical | Allergy/Clinical Immunology | Modified | — |
| Tezspire (tezepelumab) Medical Benefit Medication Utilization Policy | Community-Care | Clinical | Allergy/Clinical Immunology | Modified | — |
| Xolair | Community-Care | Clinical | Allergy/Clinical Immunology | Modified | — |
Rows per page:1–10 of 113
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.