Criteria and Clinical Medical Policies

Click here to get back to the main Pharmacy page.

Pharmacy Criteria

Clinical Medical Policies

The Medical Review staff of the Medical Management Department utilize clinical medical policies (CMPs) 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 CMPs are developed according to evidence-based outcomes.

To view one of Neighborhood’s approved CMPs, please click the link below: