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

Participating providers can comment on draft policies using one of the following methods:

  • 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-0001 Abraxane® (paclitaxel protein-bound particles) (Intravenous)
VP-0004 Adcetris® (brentuximab vedotin) (Intravenous)
VP-0007 Pemetrexed: Alimta®; Pemfexy™ (Intravenous)
VP-0014 Bevacizumab: Avastin®; Mvasi®; Zirabev™; Alymsys® (Intravenous)
VP-0057 Trastuzumab: Herceptin®; Ogivri™; Kanjinti™; Trazimera™; Herzuma™; Ontruzant™ (Intravenous)
VP-0071 Immune Globulins (immunoglobulin) (Intravenous)
VP-0092 Kadcyla® (ado-trastuzumab emtansine) (Intravenous)
VP-0096 Perjeta® (pertuzumab) (Intravenous)
VP-0109 Rituximab: Rituxan®, Truxima®, Ruxience®, Riabni™ (Intravenous)
VP-0137 Velcade® (bortezomib) (Intravenous/Subcutaneous)
VP-0148 Yervoy™ (ipilimumab) (Intravenous)
VP-0157 Kyprolis® (carfilzomib) (Intravenous)
VP-0184 Gazyva (obinutuzumab) (Intravenous)
VP-0209 Keytruda® (pembrolizumab) (Intravenous)
VP-0226 Opdivo® (nivolumab) (Intravenous)
VP-0234 Colony Stimulating Factors – Pegfilgrastim: Neulasta®; Fulphila®; Udenyca®; Ziextenzo™; Nyvepria™; Fylnetra®; Stimufend® (Subcutaneous)
VP-0266 Darzalex™ (daratumumab) (Intravenous)
VP-0278 Tecentriq™ (atezolizumab) (Intravenous)
VP-0295 Bavencio® (avelumab) (Intravenous)
VP-0301 Imfinzi™ (durvalumab) (Intravenous)
VP-0317 Besponsa (inotuzumab ozogamicin) (Intravenous)
VP-0319 Kymriah (tisagenlecleucel) (Intravenous)
VP-0320 Mylotarg (gemtuzumab ozogamicin) (Intravenous)
VP-0333 Yescarta™ (axicabtagene ciloleucel) (Intravenous)
VP-0393 Lumoxiti™ (moxetumomab pasudotox-tdfk) (Intravenous)
VP-0558 Tecartus™ (brexucabtagene autoleucel) (Intravenous)
VP-0559 Monjuvi™ (tafasitamab-cxix) (Intravenous)
VP-0590 Breyanzi® (lisocabtagene maraleucel) (Intravenous)
VP-0598 Abecma® (idecabtagene vicleucel) (Intravenous)
VP-0599 Jemperli® (dostarlimab-gxly) (Intravenous)
VP-0658 Kimmtrak® (tebentafusp-tebn) (Intravenous)
VP-0663 Carvykti™ (ciltacabtagene autoleucel) (Intravenous)
VP-0676 Rolvedon™ (eflapegrastim-xnst) (Subcutaneous)
VP-0679 Pedmark® (sodium thiosulfate) (Intravenous)
VP-0682 Tecvayli™ (teclistamab-cqyv) (Subcutaneous)
VP-0683 Imjudo® (tremelimumab-actl) (Intravenous)
VP-0686 Elahere™ (mirvetuximab soravtansine-gynx) (Intravenous)