SI
SI
discoversearch

We've detected that you're using an ad content blocking browser plug-in or feature. Ads provide a critical source of revenue to the continued operation of Silicon Investor.  We ask that you disable ad blocking while on Silicon Investor in the best interests of our community.  If you are not using an ad blocker but are still receiving this message, make sure your browser's tracking protection is set to the 'standard' level.
Biotech / Medical : XOMA. Bull or Bear?
XOMA 32.13-0.5%Nov 28 9:30 AM EST
 Public ReplyPrvt ReplyMark as Last ReadFilePrevious 10Next 10PreviousNext  
To: Bluegreen who wrote (16595)2/10/2004 2:00:50 AM
From: aknahow  Read Replies (1) of 17367
 
Does it qualify as medically necessary after 12 months? Not according to Aetna's contorted logic.

Policy

Aetna considers biological therapies alefacept (Amevive) and efalizumab (Raptiva) medically necessary for adults aged 18 and older with moderate-to-severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy when the following selection criteria are met:

1. Plaque psoriasis has been present for more than 1 year; and
2. Ten percent or more body surface area is affected by plaque psoriasis; and
3. Member has failed to adequately respond to or is intolerant to a three or more month trial of one of the following photochemotherapies (unless contraindicated):
a. psoralens (methoxsalen, trioxsalen) with UVA light (PUVA); or
b. UVB with coal tar or dithranol;

and

4. Member has not already been received the referenced biological therapy for a duration of 12 months.

Efalizumab is considered experimental and investigational for treatment durations of longer than 12 months. According to the FDA approved labeling, the safety and effectiveness of treatment with efalizumab beyond one year have not been established.
/////////////////////////////////////////////////////////////////////////////////////////////////
Or cut to the chase and deal with number four.

"4. Member has not already been received the referenced biological therapy for a duration of 12 months. "
Report TOU ViolationShare This Post
 Public ReplyPrvt ReplyMark as Last ReadFilePrevious 10Next 10PreviousNext  

HomeMailHotSubjectMarksPeopleMarksKeepersSettings
Terms Of UseContact UsCopyright/IP PolicyPrivacy PolicyAbout UsFAQAdvertise on SI
© 2025 Knight Sac Media.  Data provided by Twelve Data, Alpha Vantage, and CityFALCON News