Mass General Brigham Health Plan policy updates
Track new and updated Mass General Brigham Health Plan policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Imlygic (talimogene laherparepvec, T-VEC) medical necessity | Mass General Brigham Health Plan | Clinical | Hematology/Oncology | Modified | Aug 1, 2026 |
| Krintafel (tafenoquine) prior authorization for P. vivax relapse prevention | Mass General Brigham Health Plan | Clinical | Infectious Disease | Modified | Aug 1, 2026 |
| Medical Necessity Guidelines — Inpatient Surgical Care | Mass General Brigham Health Plan | Clinical | General Surgery | Modified | Aug 1, 2026 |
| Diagnosis of Sleep Disordered Breathing in Adults and Children | Mass General Brigham Health Plan | Clinical | Sleep Medicine | Modified | Aug 1, 2026 |
| Positive Airway Pressure therapy for sleep disordered breathing | Mass General Brigham Health Plan | Clinical | Sleep Medicine | Modified | Aug 1, 2026 |
| Omalizumab (Xolair) and related biologics coverage | Mass General Brigham Health Plan | Clinical | Allergy/Clinical Immunology | Modified | Jul 1, 2026 |
| Emrelis (telisotuzumab vedotin‑tllv) — Coverage Criteria | Mass General Brigham Health Plan | Clinical | Hematology/Oncology | Modified | Jul 1, 2026 |
| Datroway (datopotamab deruxtecan-dlnk) and related breast cancer therapies — Medical benefit prior authorization criteria | Mass General Brigham Health Plan | Clinical | Hematology/Oncology | Modified | Jul 1, 2026 |
| Long-Acting Colony Stimulating Factors (pegfilgrastim and efbemalenograstim biosimilars) | Mass General Brigham Health Plan | Clinical | Hematology/Oncology | Modified | Jul 1, 2026 |
| Medical Necessity Guidelines — Xofigo (radium Ra-223 dichloride) | Mass General Brigham Health Plan | Clinical | Hematology/Oncology | Modified | Jul 1, 2026 |
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.
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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.