Member Services: 1-866-255-4795 | TTY:711
Call to Enroll: 1-833-698-1049 | TTY:711
Clinical Criteria
Brand New Day Clinical Criteria
Medical Policies
Criterion Modification Policy
Ambulance Services - Medical Transportation
Adult Sleep Studies
Arthroscopic Knee Surgery
Autologous Chondrocyte Implantation (ACI)
Bariatric Surgery
Cervical Spine
Continuity of Care/Transition of Care
Criterion Modification Policy
Dental Services
Drug Testing
Genetic Testing
Home Health Services
Hospital Stay Requirement SNF
Investigational or Experimental Services and Clinical Trials
Liver Fibrosis Serum Testing
Short Stay Admissions and Outpatient Hospital Observation
Pulsed Dye Laser
Readmission Review
Site of Service
Sacroiliac Joint Infections
Sepsis and Septic Shock
Skilled Nursing Facility Services
Temporomandibular Joint (TMJ) Disorders
Total or Partial Knee Arthroplasty
Tumor Treating Fields - Optune
Varicose Veins (Clinical Criteria Modification)
Step Therapy
Part B Step Therapy Drug List
Antineoplastic – bevacizumab
Antineoplastic - rituximab
Antineoplastic – trastuzumab
Anti-inflammatory infliximab
Colony Stimulating Factors Long Acting
Colony Stimulating Factors – Short Acting
Hyaluronate Injections for Osteoarthritis of the Knee
Medical Pharmacy Policies
Abecma - idecabtagene vicleucel
Actemra - tocilizumab
Adakveo - crizanlizumab-tmca
Aduhelm - aducanumab-avwa
Alimta - pemetrexed
Aloxi - palonosetron
Alpha-1-Proteinase Inhibitors: Aralast/Prolastin/Zemaira/Glassia
Amvuttra
Breyanzi - lisocabtagene maraleucel
Briumvi
Cabenuva - cabotegravir and rilpivirine
Carvykti
Cerezyme (imiglucerase)
Cimzia - certolizumab pegol
Clotting Disorder Therapy
Cosela - trilaciclib
Cresemba - isavuconazonium sulfate
Dalvance - dalbavancin
Duchenne Muscular Dystrophy (DMD)
Elahere
Emend - fosaprepitant dimeglumine
Empaveli - pegcetacoplan
Enjaymo
Entyvio - vedolizumab
Evenity - romosozumab
Evkeeza - evinacumab
Fasenra - benralizumab
Feraheme
Fyarro - sirolimus albumin-bound
Givlaari - givosiran
Hemgenix
Ilaris - canakinumab
Ilumya - tildrakizumab-asmn
Imjudo
Intravenous Immune Globulins (IVIG)
Intravitreal Injections/Implants
Isodax_romidepsin
Jemperli - dostarlimab
Khapzory - levoleucovorin
Kimmtrack - tebentafusp-tebn
Krystexxa - pegloticase
Kymriah - tisagenlecleucel
Leqembi
Leqvio - inclisiran
Lunsumio
Lupron Depot-Lupron Depot-Ped Eligard-Fensolvi-Camcevi - leuprolide
Luxturna - voretigene neparvovec
Mepsevii - vestronidase alfa-vjbk
Nexviazyme - avalglucosidase alfa-ngpt
Nulibry - fosdenopterin hydrobromide
Nulojix - belatacept
Off Label Indications
Opdualag
Orencia - abatacept
Padcev - enfortumab vedotin-ejfv
Pepaxto - melphalan flufenamide
Pulmonary Arterial Hypertension
Reblozyl - luspatercept-aamt
Relizorb - immobilized lipase
Rybrevant - amivantamab
Saphnelo - anifrolumab-fnia
Sarclisa - isatuximab
Signifor LAR - pasireotide
Simponi ARIA - golimumab
Skysona
Somatuline Depot - lanreotide
Spevigo
Spinraza - nusinersen
Stelara - ustekinumab
Subcutaneous Immune Globulins (SCIG)
Sunlenca
Supprelin LA - histrelin
Synagis - palivizumab
Takhyzro - lanadelumab-flyo
Tecartus - brexucabtagene autoleucel
Tecvayli
Tepezza - teprotumumab-trbw
Tezspire - tezepelumab-ekko
Tivdak - tisotumab vedotin
Trelstar
Triptodur - triptorelin
Tzield
Vimizim - elosulfase alfa
Vyepti - eptinezumab-jjmr
Vyvgart - efgartigimod alfa-fcab
Xenpozyme
Yescarta - axicabtagene ciloleucel
Zepzelca - lurbinectedin
Zilretta - triamcinolone acetonide
Zolgensma - onasemnogene abeparvovec-xioi
Zulresso - brexanolone
Zynlonta - loncastuximab tesirine
Zynteglo (betibeglongene autotemcel)
For additional clinical criteria please register by entering your name and email address. The same email address associated with your Brand New Day plan.
P.O. Box 93122 Long Beach, CA 90809
Universal Care, Inc. dba Brand New Day. All Rights Reserved © 2023
