Cancer Therapy Prior Authorization Update

Effective Jan. 2. 2021, prior authorization for certain outpatient injectable chemotherapy and related cancer therapies for members with a cancer diagnosis will be required for Medicare Advantage plans including:

  • Medica and Preferred Care Partners of Florida plans
  • UnitedHealthcare West plans (noted by ‘WEST’ on the back of the member ID card)

To submit an online request for prior authorization, sign in to Link to access the Prior Authorization and Notification tool. Select the “Radiology, Cardiology + Oncology” box. After selecting Medicare as the product type, you will be directed to another website to process the authorization requests.

You can find detailed prior authorization code lists for the following on UHCprovider.com:

  • Outpatient Injectable Chemotherapy and Related Cancer Therapies
  • Therapeutic Radiopharmaceuticals

If a member receives injectable chemotherapy drugs or related cancer therapies in an outpatient setting between Oct. 1, 2020 and Dec. 31, 2020 you don’t need to request prior authorization until you administer a new chemotherapy drug or related cancer therapy. We will authorize the chemotherapy regimen the member was receiving prior to Jan. 1, 2021. The authorization will be effective until Dec. 31, 2021.

Questions? Please email unitedoncology@uhc.com.