September 01, 2022

New oral oncology prior authorization process

Last modified: September 06, 2022

Effective Oct. 3, 2022, you can submit chemotherapeutic prior authorization requests using the Medical Benefit Management (MBMNow) tool for your patients who have pharmacy benefits through OptumRx. This applies to members with UnitedHealthcare commercial and Individual Exchange plans¹. You’ll no longer need to submit these prior authorization requests to OptumRx.

With this new process, you can manage your prior authorization requests for oncology medications using the same process as infused chemotherapies.

Affected plans Non-affected health plans
Individual Exchange plans (all states) Golden Rule
Commercial plans Student Resource
All Savers Sierra/Health Plan of Nevada
Neighborhood Health Plan UHC International
River Valley UHC West
Oxford

 

New prior authorization request process

As of Oct. 3, please submit prior authorization requests using one of the following options:

  • Online:

1. Sign into the Provider Portal using your One Healthcare ID

2. Select Prior Authorization

3. Select the Radiology, Cardiology, Oncology and Radiation Oncology Transactions tile

4. Select the Radiation Oncology service type and the appropriate product type from the dropdown

5. Follow the prompts to access the Medical Benefit Management (MBMNow) tool

  • Phone: Call Specialty Services at 888-397-8129

Coverage determination guidelines

Coverage determinations won’t change due to this new prior authorization request process.

For members currently receiving oral chemotherapeutic agents

If you already have prior authorization approval for a member’s treatment plan, you don’t need to submit a new request.

Questions?

If you have questions, please email cancerauthorizationprogram@optum.com.

¹Also referred to as Individual and Family plans
PCA-1-22-02504-PH-News-09062022
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