Draft Provider-Administered Oncology Drug Policies

Draft policies are listed below. If there are no policies listed, it means there are currently no policies in draft status.

 

Note: Coverage is subject to member's specific benefits. Group specific policies will supersede these policies when applicable. Please refer to member's benefit plan.

Comment on Draft Oncology Drug Policies

Participating providers are invited to submit for consideration scientific, evidence-based information, professional consensus opinions and other information supported by medical literature relevant to draft policies.

Comments are accepted for 45 days from the posting date listed on the draft policy.

Make sure your voice is heard by providing feedback directly to us:

Birmingham Service Center
Attn: Health Management — Medical Policy
P.O. Box 10527
Birmingham, AL 35202


Fax: 205-220-0878

Draft Policies

Policy # Policy Title Print View
VP-0014 Bevacizumab: Avastin®; Mvasi™; Zirabev™ (Intravenous)
VP-0036 Emend® (fosaprepitant dimeglumine) (Intravenous)
VP-0072 Ixempra® (ixabepilone) (Intravenous)
VP-0208 Arzerra® (ofatumumab) (Intravenous)
VP-0209 Keytruda® (pembrolizumab) (Intravenous)
VP-0226 Opdivo® (nivolumab) (Intravenous)
VP-0234 Colony Stimulating Factors – Pegfilgrastim: Neulasta®; Fulphila™; Udenyca™; Ziextenzo™; Nyvepria™ (Subcutaneous)
VP-0235 Colony Stimulating Factors: Filgrastim (Neupogen®); Filgrastim-aafi (Nivestym™); Filgrastim-sndz (Zarxio®); Filgrastim-ayow (Releuko®); Tbo-Filgrastim (Granix®) (Subcutaneous/Intravenous)
VP-0237 Colony Stimulating Factors: Leukine® (sargramostim) (Subcutaneous/Intravenous)
VP-0267 Portrazza™ (necitumumab) (Intravenous)
VP-0274 Imlygic™ (talimogene laherparepvec) Intralesional
VP-0333 Yescarta™ (axicabtagene ciloleucel) (Intravenous)
VP-0336 Cinvanti™ (aprepitant) (Intravenous)
VP-0503 Reblozyl® (luspatercept-aamt) (Subcutaneous)
VP-0607 Rybrevant™ (amivantamab-vmjw) (Intravenous)
VP-0663 Carvykti™ (ciltacabtagene autoleucel) (Intravenous)
VP-0664 Opdualag™ (nivolumab/relatlimab-rmbw) (Intravenous)