Draft Provider-Administered Oncology Policies

To ensure that the development of medical policies occurs through an open, collaborative process, we welcome comments about medical policies that are in the draft stage. Our current draft policies are listed below.

Participating providers are invited to submit scientific, evidence-based information, professional consensus opinions and other information supported by medical literature relevant to these draft policies for consideration. We accept comments for 45 days from the posting date listed on the draft policy document.

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.

How to Submit Comments on Draft Medical Policies

Complete our medical policy feedback form

Or send comments by mail or fax to:

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

Fax: 205-220-0878

Policy # Policy Title Print View
VP-0038 Erbitux® (cetuximab) (Intravenous)
VP-0100 Provenge® (sipuleucel-T) (Intravenous)
VP-0209 Keytruda® (pembrolizumab) (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™); Tbo-Filgrastim (Granix®) (Subcutaneous/Intravenous)
VP-0237 Colony Stimulating Factors: Leukine® (sargramostim) (Subcutaneous/Intravenous)
VP-0278 Tecentriq™ (atezolizumab) (Intravenous)
VP-0301 Imfinzi™ (durvalumab) (Intravenous)
VP-0528 Sarclisa® (isatuximab-irfc) (Intravenous)
VP-0531 Jelmyto™ (mitomycin) (Intra-pyelocalyceal)
VP-0532 Trodelvy™ (sacituzumab govitecan-hziy) (Intravenous)
VP-0595 Pepaxto® (melphalan flufenamide) (Intravenous)
VP-0598 Abecma® (idecabtagene vicleucel) (Intravenous)
VP-0599 Jemperli® (dostarlimab-gxly) (Intravenous)
VP-0600 Zynlonta™ (loncastuximab tesirine-lpyl) (Intravenous)