Miscellaneous Oncology Drugs (medical necessity criteria)
Defines medical necessity and coverage criteria for a set of miscellaneous oral oncology drugs (e.g., hedgehog inhibitors, IDH inhibitors, PARP inhibitors, CDK4/6 inhibitors, JAK inhibitors, NTRK/TRK inhibitors, others) for Premera Blue Cross members and providers.
Added coverage criteria for multiple drugs including Lonsurf, Hepzato Kit, Ogsiveo, Tabloid, Iwilfin, Rytelo, Tepylute, Tecelra, Vyloy, Beizray, Revuforj, Romvimza, Amtagvi, Ojjaara, Aphexda, Amtagvi (lifileucel), and others across 2023-2025 updates.
Updated coverage criteria and age requirements for several targeted agents (e.g., Retevmo selpercatinib age limits and indications; Rytelo (imetelstat) added for MDS).
Removed Blenrep (belantamab mafodotin-blmf) from the policy as the drug is being withdrawn from the market.
Removed Truseltiq (infigratinib) coverage criteria as the product has been withdrawn from the market.
Clarified that medications listed are subject to the product's FDA dosage and administration prescribing information and that non-formulary exception reviews may be approved up to 12 months.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.