Criteria and Clinical Medical Policies

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Pharmacy Criteria

Medical and Behavioral Health Coverage Policies

The Medical Review staff of the Medical Management Department utilize coverage policies to guide decisions regarding Neighborhood’s Conditional Benefits.

Click here to access the Medical Pharmacy Benefit Searchable HCPCS Listing (Including J-Codes)

Through collaboration with Neighborhood’s Associate Medical Director, and our specialty consultants, the policies are developed and/or revised following thorough review of current medical literature and standards of practice. To the extent possible, Neighborhood’s Coverage Policies are developed according to evidence-based outcomes.

To view one of Neighborhood’s approved Coverage Policies, please click the links below: