CurrentFidelis CarePolicy N/A

Oncology medications and supportive agents authorization list

Governs prior review/authorization requirements for oncology medications and supportive agents for Fidelis Care Medicaid Managed Care & HealthierLife members, including drugs requiring review by Evolent (formerly New Century Health) prior to dispense or administration.

Policy Summary

PayerFidelis Care

PolicyOncology medications and supportive agents authorization list

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit the entire oncology regimen to New Century Health via their web portal or phone for review and authorization prior to dispensing or administration.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~900+HCPCS/CPT/J-codes and products listed for authorization

Members 18+Population affected

Multiple J/Q/C codesCode series affected

Coverage & Submission Requirements

Unsupported block type: object

Regimen Submission Requirement

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Regimen	Coverage requirement
All oncology regimens for which any listed drugs are used	Providers must submit the entire oncology regimen to New Century Health (NCH) for review and obtain prior review/authorization before dispensing or administration. Requests can be submitted via NCH's web portal or by phone. Omitting any drug from the regimen submission may result in denial.
Scope note	Do not submit requests for items explicitly out of scope to NCH (examples: antibiotics; bone marrow/stem cell transplants; CAR-T therapy; Cablivi; controlled substances; equipment requests such as infusion pumps; genetic lab testing/laboratory services; hemophilia drugs; immune globulins; inpatient drug requests; iron preparations; pain medications; radiopharmaceuticals; surgeries/surgical procedures; sickle cell diagnoses).

Regimen

Coverage requirement

All oncology regimens for which any listed drugs are used

Providers must submit the entire oncology regimen to New Century Health (NCH) for review and obtain prior review/authorization before dispensing or administration. Requests can be submitted via NCH's web portal or by phone. Omitting any drug from the regimen submission may result in denial.

Scope note

Do not submit requests for items explicitly out of scope to NCH (examples: antibiotics; bone marrow/stem cell transplants; CAR-T therapy; Cablivi; controlled substances; equipment requests such as infusion pumps; genetic lab testing/laboratory services; hemophilia drugs; immune globulins; inpatient drug requests; iron preparations; pain medications; radiopharmaceuticals; surgeries/surgical procedures; sickle cell diagnoses).

Denial Risk

Regimen completeness required — omissions risk denial

Omitting any drug from the oncology regimen when submitting to New Century Health may result in a denial of the request.

Submit every agent in the planned regimen to NCH, even if a component may not independently require prior authorization.

What Providers Must Do

Prior Authorization

Authorization required for listed oncology HCPCS/J/Q codes

Many HCPCS/J/Q and miscellaneous codes listed in the policy require prior authorization and review by New Century Health before the drug is dispensed or administered.

Examples and a full enumerated list of affected HCPCS/J/Q codes are provided in the coding section of the document.

Note

Provider alert — follow NCH review process and scope

Alert: Requests for oncology medications must follow the payer's NCH review process and include the full regimen; failure to follow submission requirements may delay or deny service.

Confirm the member is within the covered population (members 18+; pediatric inclusion effective 7/1/2022).
Do not submit out-of-scope items (e.g., antibiotics, CAR-T, inpatient drug requests).

Documentation Required

Submit regimen to NCH via web portal or phone for review

Submit the entire oncology regimen to New Century Health via NCH's web portal (my.newcenturyhealth.com) or by phone (1-888-999-7713). Requests require review by NCH prior to dispensing or administration.

Use NCH web portal or call 1-888-999-7713 to initiate the review.
Include all regimen components and member age information (adult vs pediatric per effective dates).

HCPCS / J / Q Code Lists

Listed HCPCS (examples)HCPCSCovered

C9293

GLUCARPIDASE

Covered HCPCS/J/Q codes (full enumerated list)mixedCovered

J0100-J9999 (multiple specific J-codes listed)	Multiple J-codes and injectable oncology/supportive agents enumerated across document chunks
J8999	Unclassified/other J-code mappings for many specific oral and targeted oncology agents (numerous specific drug mappings listed)
J9OOO	DOXORUBICIN HCL INJECTION (listed as J9OOO in document)
Q5101-Q5130	Enumerated Q-codes for biosimilars and related products (pegfilgrastim, filgrastim, trastuzumab, bevacizumab biosimilars, rituximab biosimilars, etc.)

Policy Background

This document is an administrative coverage and authorization list that identifies oncology medications and supportive agents requiring pre‑dispense or pre‑administration review by Evolent (formerly New Century Health, NCH) for Fidelis Care Medicaid Managed Care & HealthierLife members. It applies to drugs administered in the pharmacy, physician office, outpatient hospital, or ambulatory settings for members aged 18 and older (pediatric membership added starting 7/1/2022).

Providers must submit the entire oncology regimen to NCH via the NCH web portal (my.newcenturyhealth.com) or by phone (1‑888‑999‑7713) for review and authorization prior to dispensing or administration; omitting any drug from the regimen may result in a denial.

Key Definitions

New Century Health (NCH) / Evolent — external review organization

OrganizationNew Century Health (NCH) / Evolent

RoleExternal oncology review organization that performs pre-dispense/administration review for oncology medications and supportive agents for this payer

ScopeReviews oncology medication requests for pharmacy, physician office, outpatient hospital, and ambulatory settings for members age 18+ (pediatric inclusion beginning 7/1/2022)

Submission methodsRequests submitted via NCH web portal (mynewcenturyhealth.com) or by phone at 1-888-999-7713

Regimen requirementProvider must submit the entire oncology regimen to NCH; omitting any drug may result in a denial