Oxford injectable cancer therapy prior authorization

Effective Aug. 1, 2021, Optum, an affiliate company of UnitedHealthcare, will manage UnitedHealthcare Oxford prior authorization requests for outpatient injectable chemotherapy and related cancer therapies for members with a cancer diagnosis.

Any active prior authorizations requested through the former process will remain in place. A new prior authorization request will be required when adding a new injectable chemotherapy drug or cancer therapy to an existing regimen.

Existing prior authorization requirements formerly managed by eviCore will continue for:

  • Chemotherapy and biologic therapy injectable drugs
  • Therapeutic radiopharmaceutical drugs
  • White Blood Cell Colony Stimulating Factors
  • Denosumab

The respective medical policies have been updated for the change in utilization management vendor, and preferred product criteria has been added to the oncology medications.

Anti-emetics and Leuprolide acetate prior authorization

Also effective Aug. 1, 2021, prior authorization will be required for 8 anti-emetics codes and leuprolide acetate for UnitedHealthcare Oxford members with a cancer diagnosis.

If a member receives any of these 8 anti-emetic drugs and/or leuprolide acetate in an outpatient setting from May 1, 2021, through July 31, 2021, you do not need to submit a prior authorization request until a new chemotherapy drug will be administered. We’ll authorize the chemotherapy regimen the member was receiving prior to Aug. 1, 2021, and the authorization will be effective until Jan. 31, 2022, unless a change in treatment is needed.

Updated medical policies

On Aug. 1, 2021, the following Medical Benefit Drug Policies will be available at UnitedHealthcare Oxford Medical & Drug Policies and Coverage Determination Guidelines:

  • Oncology Medication Clinical Coverage (formerly titled Injectable Chemotherapy Drugs: Application of NCCN Clinical Practice Guidelines)
  • White Blood Cell Colony Stimulating Factors
  • Denosumab (Prolia®& Xgeva®)
  • Antiemetics for Oncology (new medical policy)

Prior to Aug. 1, 2021, policies are at UnitedHealthcare Oxford Medical Policy Update Bulletin: May 2021.

Requesting prior authorization

To request prior authorization, log on to the Provider Portal at UHCprovider.com > Sign in to access the online Prior Authorization and Notification tool. Select Radiology, Cardiology + Oncology and you'll be directed to a new website to process these authorization requests. You can submit an online request beginning July 30, 2021, for dates of service on or after Aug. 1, 2021. For members with an alpha-numeric group number, you should obtain prior authorization by calling the number on the back of the member's ID card.

Cancer Therapy Pathways

The Cancer Therapy Pathways program is also available through the Provider Portal at UHCprovider.com > Sign in when submitting a prior authorization request for:

  • UnitedHealthcare commercial plans
  • UnitedHealthcare Oxford commercial plans - effective Aug. 1, 2021
  • UnitedHealthcare affiliate health plans
  • UnitedHealthcare Community Plan
  • UnitedHealthcare Medicare Advantage Plan

Additional resources

Get additional resources at Prior Authorization for Chemotherapy and Related Cancer Therapies, including frequently asked questions and quick reference guides.

Find training and more at UHCprovider.com/paan

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