We are aware of a nationwide cyber security incident impacting Change HealthCare. Our PHP portals are not impacted by this incident. Click here for more information.

PHP Medical & Drug Policies

Archived Drug Determination Policies (DDP)

Archived General Policies (DDP)

Dose Rounding and Wastage (DDP-21)
Policy for dosage rounding
Effective Date: 04.26.2023
Dose Rounding and Wastage (DDP-21)
Policy for dosage rounding
Effective Date: 02.22.2023
Dose Rounding and Wastage (DDP-21)
Policy for dosage rounding
Effective Date: 12.14.2022
Dose Rounding and Wastage (DDP-21)
Policy for dosage rounding
Effective Date: 1/14/2022
Dose Rounding and Wastage (DDP-21)
Policy for dosage rounding
Effective Date: 3/9/2021
Dose Rounding and Wastage (DDP-21)
Policy for dosage rounding
Effective Date: 9/5/2019
Dose rounding
Policy for dosage rounding
Effective Date: 8/22/2018
Formulary Alternatives and Exclusions (DDP-02)
Based upon benefit design, a list of these medications may be found in the prescription drug list, in the HCPCS notification table for provider-administered medications or by calling PHP customer service.
Effective Date: 04.26.2023
Formulary Alternatives and Exclusions (DDP-02)
Based upon benefit design, a list of these medications may be found in the prescription drug list, in the HCPCS notification table for provider-administered medications or by calling PHP customer service.
Effective Date: 02.22.2023
Formulary Alternatives and Exclusions (DDP-02)
Based upon benefit design, a list of these medications may be found in the prescription drug list, in the HCPCS notification table for provider-administered medications or by calling PHP customer service.
Effective Date: 12.14.2022
Formulary Alternatives and Exclusions (DDP-02)
Based upon benefit design, a list of these medications may be found in the prescription drug list, in the HCPCS notification table for provider-administered medications or by calling PHP customer service.
Effective Date: 1/14/2022
Formulary Alternatives and Exclusions (DDP-02)
Based upon benefit design, a list of these medications may be found in the prescription drug list, in the HCPCS notification table for provider-administered medications or by calling PHP customer service.
Effective Date: 06/29/2021
Formulary Alternatives and Exclusions (DDP-02)
Based upon benefit design, a list of these medications may be found in the prescription drug list, in the HCPCS notification table for provider-administered medications or by calling PHP customer service.
Effective Date: 3/09/2021
Formulary Alternatives and Exclusions (DDP-02)
Based upon benefit design, a list of these medications may be found in the prescription drug list, in the HCPCS notification table for provider-administered medications or by calling PHP customer service.
Effective Date: 6/29/2020
Formulary Alternatives and Exclusions (DDP-02)
Based upon benefit design, a list of these medications may be found in the prescription drug list, in the HCPCS notification table for provider-administered medications or by calling PHP customer service.
Effective Date: 10/14/2019
Formulary Alternatives and Exclusions (DDP-02)
Based upon benefit design, a list of these medications may be found in the prescription drug list, in the HCPCS notification table for provider-administered medications or by calling PHP customer service.
Effective Date: 06/4/2019
Policy on Use of Formulary Alternatives
Based upon benefit design, a list of these medications may be found in the prescription drug list, in the HCPCS notification table for provider-administered medications or by calling PHP customer service.
Effective Date: 2/27/2019
Oncology Products (DDP-52)
Based upon benefit design, a list of these oncology medications may be found in the prescription drug list, in the HCPCS notification table for provider-administered medications or by calling PHP customer service.
Effective Date: 12.13.2021
Site of Care for Administration of Parenteral Specialty Drugs (DDP-08)
Determination process for coverage of specific specialty medications at an outpatient facility that bills with a facility fee. Medications included in this policy must also meet medication prior approval criteria for coverage, regardless of the site of service.

Actemra, Benlysta, Bivigam, Briumvi, Carimune, Cinqair, Cuvitru, Entyvio, Evkeeza, Fasenra, Flebogamma, GamaSTAN, Gammagard, Gammaplex, Gamunex-C, Gammaked, Hizentra, HyQvia, Inflectra, Leqvio, Nucala, Ocrevus, Octagam, Orencia, Panzyga, Privigen, Remicade, Renflexis, Simponi Aria, Stelara, Synagis, Tysabri, Vivaglobin, Vyepti, Xolair

Effective Date: 10.25.2023
Site of Care for Administration of Parenteral Specialty Drugs (DDP-08)
Determination process for coverage of specific specialty medications at an outpatient facility that bills with a facility fee. Medications included in this policy must also meet medication prior approval criteria for coverage, regardless of the site of service.
Effective Date: 04.26.2023
Site of Care for Administration of Parenteral Specialty Drugs (DDP-08)
Determination process for coverage of specific specialty medications at an outpatient facility that bills with a facility fee. Medications included in this policy must also meet medication prior approval criteria for coverage, regardless of the site of service.
Effective Date: 02.22.2023
Site of Care for Administration of Parenteral Specialty Drugs (DDP-08)
Determination process for coverage of specific specialty medications at an outpatient facility that bills with a facility fee. Medications included in this policy must also meet medication prior approval criteria for coverage, regardless of the site of service.
Effective Date: 11.23.2022
Site of Care for Administration of Parenteral Specialty Drugs (DDP-08)
Determination process for coverage of specific specialty medications at an outpatient facility that bills with a facility fee. Medications included in this policy must also meet medication prior approval criteria for coverage, regardless of the site of service.
Effective Date: 08/24/2022
Site of Care for Administration of Parenteral Specialty Drugs (DDP-08)
Determination process for coverage of specific specialty medications at an outpatient facility that bills with a facility fee. Medications included in this policy must also meet medication prior approval criteria for coverage, regardless of the site of service.
Effective Date: 01/14/2022
Site of Care for Administration of Parenteral Specialty Drugs (DDP-08)
Determination process for coverage of specific specialty medications at an outpatient facility that bills with a facility fee. Medications included in this policy must also meet medication prior approval criteria for coverage, regardless of the site of service.
Effective Date: 3/9/2021
Site of Care for Administration of Parenteral Specialty Drugs (DDP-08)
Determination process for coverage of specific specialty medications at an outpatient facility that bills with a facility fee. Medications included in this policy must also meet medication prior approval criteria for coverage, regardless of the site of service.
Effective Date: 7/01/2019
Specialty and High Cost Agents (DDP-45)
Subject to benefit design.
Effective Date: 05.02.2022
Specialty and High Cost Agents (DDP-45)
Subject to benefit design.
Effective Date: 06/1/2021
Specialty and High Cost Agents (DDP-45)
Subject to benefit design.
Effective Date: 4/17/2020
Specialty and High Cost Agents
Subject to benefit design.
Effective Date: 7/6/2017

Archived Drug Determination Policies (DDP)

Site view: at a glance

Home
About PHP

Careers
News

- Corewell Health
- Coronavirus

Contact PHP
Sparrow
Privacy, Compliance, Terms and Legal Notices

© 2024 Physicians Health Plan
1301 N. Hagadorn Rd., Suite 1E
East Lansing, MI 48823
517.364.8400 or 800.562.6197

NCQA Accreditation Seal

Physicians Health Plan (PHP) is NCQA Accredited for its Commercial HMO/POS combined product and Health Insurance Marketplace product.

CAQH Core Seal

© 2014 Physicians Health Plan
1400 East Michigan Avenue
Lansing, MI 48912
517.364.8400 or 800.562.6197

URAC Seal

URAC Seal

Physicians Health Plan (PHP) is URAC Accredited for its HMO, Plus and Health Insurance Marketplace products.

CAQH Core Seal