Archived Policies - Medicine
Tumor (or Cancer) Vaccines are considered investigational or experimental. These vaccines include, but not limited to, the following:
Tumor (or Cancer) Vaccines claim to arm the immune system and shrink specific cancers, including melanoma, neuroblastoma, lymphoma, multiple myeloma, sarcoma, and cancers of the breast, lungs, esophagus, prostate, kidney, colorectal, and ovaries. Unlike traditional vaccines, tumor (or cancer) vaccines do not prime the immune system to prevent illness. They combat existing tumors and they also work in the same way as traditional vaccines, by activating disease-fighting white blood cells of the immune system to mount a counterattack.
Tumor cells express unique antigens to inform the immune system that something about these cells is foreign. The vaccine is a way to deliver an antigen to the immune system so that immune cells can recognize the antigen as foreign and destroy any cells bearing that antigen. These vaccines are thought to arm white blood cells (T-cells) and to destroy microscopic metastatic cells that have migrated from the primary tumor (even after the primary tumor has been removed). This type of T-cell response is also known as a tumor-associated antigen.
Additional tumor or cancer vaccine therapy categories include:
At the present time, there are no tumor or cancer vaccines with FDA approval. Some tumor vaccines that use autologous tumor tissue from the patient may not be subject to FDA approval. Phase I, II, and III clinical trials and laboratory studies are currently being conducted.
Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.
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