Cancer Therapy Pathways Program
Enhance quality and value in cancer care and get rewards when you treat patients using therapies associated with better clinical outcomes. Cancer Therapy Pathways are detailed, evidence-based regimens selected through rigorous evaluation for specific cancer types and stages.
Here are some of the available Cancer Pathways, for the full list please click on "Explore the Pathways".
- Breast
- Colon
- Head and neck
- Hepatobiliary
- Lung (small cell and non-small cell)
- Lymphoma (diffuse large b-cell (DLBCL) and high-grade b-cell)
- Melanoma
- Multiple myeloma
- Ovarian
- Pancreatic
How to participate
To participate, review the following eligibility and reward information. Then, simply start a new prior authorization request and select the appropriate regimen. You can track your participation in the Optum dashboard.
Eligibility
You can participate if:
- You submit prior authorization requests for chemotherapy or related therapies through Optum’s Cancer Guidance Program for patients who are UnitedHealthcare Community Plan, commercial or Medicare plan members
- Health care professionals in all states are eligible to use the UnitedHealthcare Cancer Therapy Pathways
Rewards
You can earn rewards for using UnitedHealthcare Cancer Therapy Pathways if:
- You’re in network for your patient’s benefit plan
- Your patient is part of a UnitedHealthcare commercial plan1 eligible for rewards2
- Excludes Hawaii, North Carolina, Puerto Rico and the U.S. Virgin Islands
- Contract amendment required to receive program rewards in California, Delaware, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island, Virginia, Washington and West Virginia
You may receive (subject to all applicable program requirements, terms and conditions) a $1,000 cash payment for each pathway regimen selected when:
- Pathway adherence is at least 75% over a 6-month period
- The minimum 5 authorizations are met during 6-month measurement period (Jan–June, July–Dec.)
How Cancer Pathways are developed
Strong basis
Regimens are based on a comprehensive literature review of all National Comprehensive Cancer Network (NCCN) recommended regimens.
Careful selection
Selection of a regimen is based on efficacy, safety/toxicity and drug cost. (Drug cost is reviewed only when efficacy and safety between regimens are comparable). We also consider UnitedHealthcare data for the duration of therapy, hospitalization rates and total cost of care.
Expert evaluation
The UnitedHealthcare Oncology Advisory Committee and disease-specific expert consultants review evaluate each pathway. Members of this committee are selected for their clinical expertise to help ensure diverse perspectives. This includes practicing medical oncologists from academic medical centers and community oncology practices who are not employed by UnitedHealthcare.
Other program details
- Pathway selection is not required to receive prior authorization approval for therapy
- Our criteria for coverage determinations for cancer therapies will not change as a result of this program
- Cancer Therapy Pathways are not a substitute for the experience and judgment of a physician or other health care professional. We don’t make decisions about the kind of care that should or shouldn’t be received. Physicians 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.
- Selecting a regimen doesn’t guarantee eligibility or reward payment
Additional resources
- Cancer Therapy Pathways Program – Terms and Conditions
- Cancer Therapy Pathways Program and Rewards – Frequently Asked Questions
- Cancer Therapy Pathways Program - Regimens
- CME Course: Achieving Value-Based Care: The Role of Oncology Clinical Pathways
Questions?
Email unitedoncology@uhc.com.
Information on this page is current as of August 2021.