Effective September 30, 2025: Clinical Policies

Date: 09/25/25

Superior HealthPlan has updated certain clinical policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result the following policies are effective on September 30, 2025, at 12:00AM.

Changes in these policies reflect preauthorization requirement amendments that are less burdensome to insureds, physicians, or health care providers.

Policy

Applicable Products

New Policy Overview or Updated Policy Revisions

Allogeneic Hematopoietic Cell Transplants for Sickle Cell Anemia and β-Thalassemia

(CP.MP.108)

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter

Policy updates include:

Removed age limit criteria from previous Criteria I.A.1.a. and previous Criteria I.A.2.a
Added clarifying language to Criteria I.A.1.b. regarding high risk of stroke
Removed first-degree relative donor requirement for cord blood as the source of stem cells for homozygous β-thalassemia in Criteria I.A.2.a.i
Removed Criteria I.A.5. regarding provider specializing in treating thalassemia
Removed serial blood and urine testing details in Criteria I.B.3
Added Note at end of Criteria I. regarding younger recipients having better outcomes following AHCT
Updated verbiage in Criteria II.C. for clarity

To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage.

Prior to updates, Medical Clinical policies are reviewed and approved by the Utilization Management Committee.

For questions or additional information, contact Superior HealthPlan Prior Authorization department at 1-800-218-7508.