Currentmedical mutual - ohioPolicy N/A

General Oncology Prior Authorization

Defines prior authorization requirements and recommended authorization criteria for oncology medications (excludes supportive care agents). Specifies required prescriber specialty, documentation, trials, diagnostic testing, and initial/extended approval durations for covered oncologic drug uses.

Policy Summary

Payermedical mutual - ohio

PolicyGeneral Oncology Prior Authorization

Policy CodePolicy N/A

Change TypeAnnual review — no material changes

Effective Date

Next Review DateJul 17, 2025

Key ActionSubmit prior authorization with required documentation and ensure the request is prescribed by or in consultation with a hematologist, oncologist, or specialist experienced in treating the cancer.

POLICY UPDATE CHANGES

No material clinical/coverage changes.

Supportive careScope Exclusion

6 moInitial Approval

1 yrExtended Approval

Oncology specialistPrescriber Requirement

Coverage Summary

This policy (General Oncology Prior Authorization) is CURRENT and applies to General Oncology Prior Authorization. It defines prior authorization requirements and recommended authorization criteria for oncology medications and requires that initial prescriptions be by or in consultation with a hematologist, oncologist, or specialist experienced in treating the cancer. The coverage stance is covered_with_criteria. Initial approval duration is 6 months and extended approval is 1 year (Initial Approval/Extended Approval). The policy's last revised and annual review date is 07/17/2025 and the next review is scheduled for the same date.

This policy explicitly excludes supportive care agents such as anti-emetics, filgrastim, and epoetin alfa from its scope. It also notes that select oncology products may be subject to additional criteria under a separate Oncology Care Value Preferred Specialty Management policy.