- Participating Physician Groups (PPG)
(does not apply to HSP)
Blood and blood plasma, and derivatives are covered.
This coverage includes all of the following:
- Community blood
- Designated donor blood
- Autologous blood (including collection and storage, is covered only for a scheduled surgery that has been authorized, even if the anticipated surgery is not performed)
Blood factors are covered under the Specialty Drug tier under the pharmacy benefit.
Any participating provider can provide antihemophilic factors (for example, Factors VIII and IX) for Food and Drug Administration (FDA)-approved indications.