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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-90001 Paclitaxel Albumin-Bound: Abraxane®; Paclitaxel Albumin-Bound Ψ
VP-90004 Adcetris® (brentuximab vedotin)
VP-90007 Pemetrexed: Alimta®; Pemfexy™; Pemrydi RTU®; Pemetrexed Ψ
VP-90014 Bevacizumab: Avastin®; Mvasi®; Zirabev®; Alymsys®; Vegzelma®; Avzivi®
VP-90038 Erbitux® (cetuximab) (Intravenous)
VP-90043 Fulvestrant: Faslodex®; Fulvestrant Ψ (Intramuscular)
VP-90055 Halaven® (eribulin)
VP-90057 Trastuzumab: Herceptin®; Ogivri®; Kanjinti®; Trazimera™; Herzuma®; Ontruzant®
VP-90092 Kadcyla® (ado-trastuzumab emtansine)
VP-90096 Perjeta® (pertuzumab)
VP-90130 Bendamustine: Treanda®; Bendeka®; Belrapzo®; Vivimusta™; Bendamustine Ψ
VP-90136 Vectibix® (panitumumab) (Intravenous)
VP-90137 Bortezomib Velcade®; Bortezomib§
VP-90148 Yervoy™ (ipilimumab) (Intravenous)
VP-90157 Kyprolis® (carfilzomib) (Intravenous)
VP-90161 Zaltrap® (ziv-aflibercept)
VP-90184 Gazyva (obinutuzumab) (Intravenous)
VP-90199 Cyramza® (ramucirumab)
VP-90209 Keytruda® (pembrolizumab)
VP-90225 Blincyto® (blinatumomab)
VP-90226 Opdivo® (nivolumab)
VP-90256 Onivyde® (irinotecan liposome injection)
VP-90257 Yondelis® (trabectedin)
VP-90266 Darzalex™ (daratumumab) (Intravenous)
VP-90268 Empliciti™ (elotuzumab) (Intravenous)
VP-90278 Tecentriq® (atezolizumab)
VP-90295 Bavencio® (avelumab) (Intravenous)
VP-90301 Imfinzi™ (durvalumab) (Intravenous)
VP-90322 Rituxan Hycela® (rituximab and hyaluronidase human)
VP-90398 Libtayo® (cemiplimab-rwlc) (Intravenous)
VP-90449 Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk)
VP-90528 Sarclisa® (isatuximab-irfc)
VP-90532 Trodelvy® (sacituzumab govitecan-hziy)
VP-90535 Darzalex Faspro® (daratumumab and hyaluronidase-fihj)
VP-90550 Zepzelca® (lurbinectedin)
VP-90553 Phesgo™ (pertuzumab, trastuzumab and hyaluronidase-zzxf)
VP-90559 Monjuvi® (tafasitamab-cxix)
VP-90583 Margenza® (margetuximab-cmkb)
VP-90599 Jemperli® (dostarlimab-gxly) (Intravenous)
VP-90600 Zynlonta® (loncastuximab tesirine-lpyl)
VP-90624 Tivdak® (tisotumab vedotin-tftv)
VP-90664 Opdualag™ (nivolumab/relatlimab-rmbw)
VP-90679 Pedmark® (sodium thiosulfate)
VP-90682 Tecvayli™ (teclistamab-cqyv)
VP-90683 Imjudo® (tremelimumab-actl) (Intravenous)
VP-90686 Elahere™ (mirvetuximab soravtansine-gynx)
VP-90692 Lunsumio™ (mosunetuzumab-axgb)
VP-90700 Zynyz™ (retifanlimab-dlwr) (Intravenous)
VP-90710 Epkinly™ (epcoritamab-bysp)
VP-90711 Columvi™ (glofitamab-gxbm)
VP-90722 Talvey™ (talquetamab-tgvs)
VP-90724 Elrexfio™ (elranatamab-bcmm)
VP-90735 Loqtorzi™ (toripalimab-tpzi) (Intravenous)
VP-90748 Amtagvi® (lifileucel)
VP-990209 Keytruda® (pembrolizumab)