This policy governs coverage of injectable oncology medications (including therapeutic radiopharmaceuticals) under the medical benefit using the National Comprehensive Cancer Network (NCCN) Drugs and Biologics Compendia® as the evidence source. It does not provide coverage criteria for Chimeric Antigen Receptor (CAR) T‑cell products or tumor‑infiltrating lymphocyte (TIL) cell products; separate guidelines address colony stimulating factors, erythropoiesis stimulating agents, bone‑modifying agents, and antiemetics. Coverage decisions depend on member benefits and alignment with NCCN compendium recommendations and evidence categories.

The provided excerpt does not list any explicit exclusions beyond the CAR T‑cell and TIL product exclusions noted elsewhere. Most chunks present a formulary‑style preferred product list; individual entries do not state additional product exclusions in the visible text.

No explicit exclusions are recorded in these chunks. The content is a preferred product listing mapping drug names to HCPCS/J and Q‑codes rather than a set of excluded therapies.

No explicit exclusions are listed in this section of the excerpt. Entries repeatedly denote products as preferred for oncology indications; exclusion language is absent.

These portions of the document present preferred product entries (many annotated “All oncology indications”) and do not state explicit exclusions for listed agents.

No exclusions are specified in these chunks. The text functions as a formulary/preferred products roster pairing agents with HCPCS/J/Q codes rather than an exclusions list.

No explicit exclusions are stated in these excerpts; the material reiterates preferred product designations (including multiple pegfilgrastim biosimilars and cytotoxic agents) without exclusionary statements for those listed.

These chunks continue the preferred products listing (pegfilgrastim group, melphalan, methotrexate, pemetrexed and others) and do not include explicit exclusions in the visible text.

Within the policy framework, therapies in the NCCN Drugs and Biologics Compendium with Category 3 evidence are considered unproved and not medically necessary for AlohaCare coverage determinations (subject to Benefits Considerations). Additionally, the J1442 listing for filgrastim is annotated as "excluded biosimilars", indicating certain biosimilars are excluded from that specific J‑code entry.

No additional explicit exclusions are stated in the provided portion of the document; the text primarily lists preferred products and applicable HCPCS/J/Q codes. Where exclusionary language appears, it is limited to the Category 3 compendia classification and the J1442 annotation noted above.

The excerpt does not enumerate further explicit exclusions. Instead, it clarifies that coverage decisions rely on NCCN evidence categories (Categories 1/2A considered proven; Category 3 considered unproved and not medically necessary) and member benefits, and that pediatric chemotherapy agents (age <19 years) are covered.

No explicit exclusions are stated in these chunks; the content is an informational preferred‑product list showing product names paired with preferred HCPCS/J‑ and Q‑codes for oncology indications.

The policy explicitly states that therapies listed in the NCCN Drugs and Biologics Compendium with Category 3 evidence are considered unproved and not medically necessary for AlohaCare coverage determinations (see Benefits Considerations). This is the principal not‑medically‑necessary rule present in the excerpt.

The J1442 line for filgrastim in the applicable codes list is annotated as "excluded biosimilars", which indicates that certain biosimilars are excluded from that specific J‑code listing. The document otherwise lists multiple biosimilar Q‑codes separately (e.g., Q5101, Q5110, etc.).

These chunks do not contain explicit "not medically necessary" statements beyond the general Category 3 rule; the document is primarily a preferred products listing and coding reference in the visible text.

No statements labeled "not medically necessary" are present in these chunks. The content repeats preferred product entries and associated codes without NMN declarations here.

No explicit "not medically necessary" conditions are listed in these sections. The preferred products lists predominate and NMN determinations are conveyed elsewhere (e.g., NCCN Category 3 language).

Not specified in these excerpts — the text lists preferred agents and codes; it does not provide additional NMN conditions beyond the Category 3 rule elsewhere in the document.

No explicit "not medically necessary" statements appear in these chunks; the policy primarily enumerates preferred products and code mappings.

These excerpts do not contain separate NMN statements; they reiterate preferred product listings and reference NCCN evidence categories which drive NMN determinations (Category 3 = not medically necessary).

No additional "not medically necessary" claims are presented in the visible text beyond the NCCN Category 3 classification noted above, which the policy uses to identify unproved therapies for coverage decisions.

Not specified in these chunks — the document section provides HCPCS/J/Q code descriptions and preferred product mappings; NMN conditions are not enumerated here other than the Category 3 rule referenced elsewhere.

The excerpt does not provide other NMN conditions. The principal NMN guidance in this section is: therapies with NCCN Category 3 evidence are considered unproved and not medically necessary for AlohaCare coverage determinations.

No new "not medically necessary" conditions are defined in these chunks. The policy relies on NCCN evidence categories to identify unproved therapies (Category 3) and otherwise lists preferred products and applicable codes.

The policy classifies agents cited in the NCCN Drugs and Biologics Compendium with Category 3 evidence as unproved and not medically necessary for AlohaCare coverage decisions; this classification is the key NMN rule present in the provided excerpts.

This guideline governs coverage of injectable oncology medications and therapeutic radiopharmaceuticals under the medical benefit using the NCCN Drugs and Biologics Compendia to establish evidence‑based indication support. Coverage for preferred products is contingent on meeting applicable coverage criteria and benefit provisions; non‑preferred products are medically necessary only when the member has documented intolerance or contraindication to two AlohaCare preferred products (unless only one preferred product exists) and the treating physician attests the same adverse event would not be expected with the requested non‑preferred agent. Pediatric chemotherapy agents (age <19 years) are covered per policy. Refer to the applicable codes table for HCPCS/J/Q mappings and note that some entries (e.g., J1442) annotate excluded biosimilars.