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
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
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.
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