Active Specific Immunotherapy: Melanoma Vaccine
DESCRIPTION
The melanoma vaccine is a type of immunotherapy that attempts to stimulate the individual's own immune system to respond to tumor antigens. The vaccine encompasses the removal of tumor cells from the individual's body, modifying them and then reintroducing them. This vaccine is focused on the therapeutic treatment rather than prevention.
POLICY
A melanoma vaccine for immunotherapy treatment is considered investigational.
APPLICABLE TENNESSEE STATE MANDATE REQUIREMENTS
Tennessee State law requires coverage of off-label indications of Food and Drug Administration (FDA) approved drugs when the off-label use is relative to life-threatening illnesses, such as cancer, AIDS, and coronary heart disease and recognized in one of the standard reference compendia (As defined in the statute: The United States Pharmacopoeia Drug Information, The American Medical Association Drug Evaluations, & The American Hospital Formulary Service Drug Information) or in the medical literature. This law is applicable to all fully insured members. The law is not applicable to self-funded accounts, but coverage for off-label uses may be provided based on the contractual agreement.
The evidence in the literature is insufficient to permit conclusions on health outcomes and effects in the use of melanoma vaccine for immunotherapy treatment.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
For appropriate dosage information, contraindications, precautions, warnings, and monitoring information, please refer to one of the standard reference compendia (e.g., The American Hospital Formulary Service Drug Information).
The evidence in the literature is insufficient to permit conclusions on health outcomes and effects in the use of melanoma vaccine for immunotherapy treatment.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2009). Melanoma vaccines (2.03.04). Retrieved January 28, 2010 from BlueWeb.
MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2010). Melanoma vaccine. Retrieved January 28, 2010 from MICROMEDEX Healthcare Series.
ORIGINAL EFFECTIVE DATE: 5/1999
MOST RECENT REVIEW DATE: 5/7/2010
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.