On Nov. 1, 2019, UnitedHealthcare will introduce a new Cancer Therapy Pathways Program to promote the use of clinically appropriate, safe, and cost-effective therapies.
The program is intended to improve quality and value in cancer care by supporting the use of therapies supported by evidence-based guidelines to improve outcomes. The program’s regimens are selected on the basis of clinical benefit (efficacy) and side-effect profile (toxicity). Among regimens with comparable efficacy and toxicity, additional consideration is given to the frequency of hospitalizations during treatment, duration of therapy, drug costs and total cost of care.
How the Program Will Work
The program will be available for most common cancer types and will include options for defined biomarkers subsets and lines of therapy. However, given the complexity of cancer, we don’t expect to have a pathway for every medical condition.
Cancer Therapy Pathways is not a substitute for the experience and judgment of a physician or other health care professional. Any clinician participating in the program must use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. Care decisions are between the physician and the patient. We do not make decisions about the kind of care that should or should not be received.
Cancer Therapy Pathways will be available through our Cancer Guidance Program online tool, through Link, when submitting an authorization request for any UnitedHealthcare commercial plan (excluding UnitedHealthcare Oxford commercial plans), UnitedHealthcare Community Plan and UnitedHealthcare Medicare Advantage Plan members. Selection of a pathway regimen is not required to receive a prior authorization for therapy. UnitedHealthcare’s criteria for coverage determinations for cancer therapies will not change as a result of this program.
Rewards for voluntary participation in the Cancer Therapy Pathways Program will be available starting in 2020 for some UnitedHealthcare commercial plans. More information on the eligibility for the program and rewards will be forthcoming.
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