Beginning Aug. 1, 2019, prior authorization for outpatient injectable chemotherapy and related cancer therapies listed below will be required for UnitedHealthcare Plan of the River Valley, Inc., UnitedHealthcare Insurance Company of the River Valley, UnitedHealthcare of the Mid-Atlantic, Inc., MAMSI Life and Health Insurance Company, Optimum Choice, Inc., and MD Individual Practice Association, Inc. Optum, an affiliate company of UnitedHealthcare, will manage these prior authorization requests.
To help ensure our member benefit coverage is medically appropriate, we regularly evaluate our medical policies, clinical programs and health benefits based on the latest scientific evidence and specialty society guidance. To support these goals, we require notification/prior authorization for injectable outpatient chemotherapy and related cancer therapies administered in an outpatient setting, including but not limited to intravenous, intravesical and intrathecal for a cancer diagnosis.
These prior authorization requirements apply to all benefit plans outlined in the table under Health Plan Effective Dates.
Adding a new injectable chemotherapy drug, colony stimulating factor or denosumab to a regimen will require new authorization.
Additional details regarding prior authorization requirements for radiopharmaceuticals can be found here.
To submit an online request for prior authorization, use the Prior Authorization and Notification tool on Link to submit your request. To access the tool, sign in to Link by going to UHCprovider.com and clicking on the Link button in the top right corner. Once you’re in the tool, select Oncology, and when prompted, answer the questions about the service type, member type and state.
Please complete all prior authorization requests online. The online system will identify the members who need a prior authorization request submitted.
UnitedHealthcare Community Plan Members in NY
UnitedHealthcare Community Plan Members in AZ, CA, FL, IA, LA, MD, MI, MS, NE, NJ, OH, PA, RI, TN, TX, WA and WI, and for UnitedHealthcare Commercial Plans
UnitedHealthcare Oxford Members
UnitedHealthcare uses National Comprehensive Cancer Network (NCCN) guidelines as independent recommendations for evidence-based cancer treatment.
Authorizations that follow NCCN regimens will be approved at the time of the request. We respond in three to five days to requests for pediatric chemotherapy regimens, rare cancers or chemotherapy regimens that aren’t NCCN-recommended if necessary supporting documentation is provided at the time of the request.
UnitedHealthcare benefit plans typically require prior authorization for injectable chemotherapy. The benefit plans that do require prior authorization are listed by line of business in alphabetical order UnitedHealthcare Community Plan is listed in alphabetical order and includes the state Medicaid name, if applicable.