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-0001 Abraxane® (paclitaxel protein-bound particles) (Intravenous)
VP-0004 Adcetris® (brentuximab vedotin) (Intravenous)
VP-0007 Alimta® (pemetrexed) (Intravenous)
VP-0014 Bevacizumab: Avastin®; Mvasi™; Zirabev™ (Intravenous)
VP-0038 Erbitux® (cetuximab) (Intravenous)
VP-0057 Trastuzumab: Herceptin®; Ogivri™; Kanjinti™; Trazimera™; Herzuma™; Ontruzant™ (Intravenous)
VP-0092 Kadcyla® (ado-trastuzumab emtansine) (Intravenous)
VP-0096 Perjeta® (pertuzumab) (Intravenous)
VP-0109 Rituximab: Rituxan®, Truxima®, Ruxience® (Intravenous)
VP-0157 Kyprolis® (carfilzomib) (Intravenous)
VP-0209 Keytruda® (pembrolizumab) (Intravenous)
VP-0226 Opdivo® (nivolumab) (Intravenous)
VP-0266 Darzalex™ (daratumumab) (Intravenous)
VP-0278 Tecentriq™ (atezolizumab) (Intravenous)
VP-0295 Bavencio® (avelumab) (Intravenous)
VP-0301 Imfinzi™ (durvalumab) (Intravenous)
VP-0482 Polivy™ (polatuzumab vedotin-piiq) (Intravenous)
VP-0531 Jelmyto™ (mitomycin) (Intra-pyelocalyceal)