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Draft Provider-Administered Oncology Drug Policies

Draft policies are listed below. If there are no policies listed, it means there are currently no policies in draft status.

Comment on Draft Drug Policies

Participating providers are invited to submit for consideration scientific, evidence-based information, professional consensus opinions, and other information supported by medical literature relevant to our draft policies.

We accept comments for 45 days from the posting date listed on the draft policy. 

Make sure your voice is heard by providing feedback directly to us:

  • Send comments and supporting documentation to us by mail or fax:

Blue Cross and Blue Shield of Alabama
Attn: Pharmacy Department
P.O. Box 995
Birmingham, AL 35298-0001

Fax: 205-220-9576

Draft Policies

Policy # Policy Title Print View
VP-90001 Paclitaxel Albumin-Bound: Abraxane®; Paclitaxel Albumin-Bound Ψ
VP-90004 Adcetris® (brentuximab vedotin)
VP-90007 Pemetrexed: Alimta®; Pemfexy™; Pemrydi RTU®; Pemetrexed Ψ
VP-90008 Aloxi® (palonosetron)
VP-90014 Bevacizumab: Avastin®; Mvasi®; Zirabev®; Alymsys®; Vegzelma®; Avzivi®
VP-90038 Erbitux® (cetuximab) (Intravenous)
VP-90043 Fulvestrant: Faslodex®; Fulvestrant Ψ (Intramuscular)
VP-90055 Halaven® (eribulin)
VP-90057 Trastuzumab: Herceptin®; Ogivri®; Kanjinti®; Trazimera™; Herzuma®; Ontruzant®
VP-90074 Cabazitaxel: Jevtana®; Cabazitaxel§
VP-90092 Kadcyla® (ado-trastuzumab emtansine)
VP-90096 Perjeta® (pertuzumab)
VP-90100 Provenge® (sipuleucel-T)
VP-90130 Bendamustine: Treanda®; Bendeka®; Belrapzo®; Vivimusta™; Bendamustine Ψ
VP-90136 Vectibix® (panitumumab) (Intravenous)
VP-90137 Bortezomib Velcade®; Bortezomib§
VP-90148 Yervoy™ (ipilimumab) (Intravenous)
VP-90157 Kyprolis® (carfilzomib) (Intravenous)
VP-90161 Zaltrap® (ziv-aflibercept)
VP-90184 Gazyva (obinutuzumab) (Intravenous)
VP-90199 Cyramza® (ramucirumab)
VP-90209 Keytruda® (pembrolizumab)
VP-90225 Blincyto® (blinatumomab)
VP-90226 Opdivo® (nivolumab)
VP-90256 Onivyde® (irinotecan liposome injection)
VP-90257 Yondelis® (trabectedin)
VP-90266 Darzalex™ (daratumumab) (Intravenous)
VP-90267 Portrazza™ (necitumumab)
VP-90268 Empliciti™ (elotuzumab) (Intravenous)
VP-90278 Tecentriq® (atezolizumab)
VP-90283 Sustol® (granisetron extended-release)
VP-90295 Bavencio® (avelumab) (Intravenous)
VP-90301 Imfinzi™ (durvalumab) (Intravenous)
VP-90317 Besponsa® (inotuzumab ozogamicin)
VP-90322 Rituxan Hycela® (rituximab and hyaluronidase human)
VP-90336 Cinvanti® (aprepitant)
VP-90363 Akynzeo® (fosnetupitant/palonosetron)
VP-90398 Libtayo® (cemiplimab-rwlc) (Intravenous)
VP-90426 Elzonris™ (tagraxofusp-erzs)
VP-90449 Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk)
VP-90503 Reblozyl® (luspatercept-aamt)
VP-90528 Sarclisa® (isatuximab-irfc)
VP-90532 Trodelvy® (sacituzumab govitecan-hziy)
VP-90535 Darzalex Faspro® (daratumumab and hyaluronidase-fihj)
VP-90550 Zepzelca® (lurbinectedin)
VP-90553 Phesgo™ (pertuzumab, trastuzumab and hyaluronidase-zzxf)
VP-90559 Monjuvi® (tafasitamab-cxix)
VP-90583 Margenza® (margetuximab-cmkb)
VP-90590 Breyanzi® (lisocabtagene maraleucel)
VP-90599 Jemperli® (dostarlimab-gxly) (Intravenous)
VP-90600 Zynlonta® (loncastuximab tesirine-lpyl)
VP-90607 Rybrevant® (amivantamab-vmjw)
VP-90624 Tivdak® (tisotumab vedotin-tftv)
VP-90664 Opdualag™ (nivolumab/relatlimab-rmbw)
VP-90679 Pedmark® (sodium thiosulfate)
VP-90682 Tecvayli™ (teclistamab-cqyv)
VP-90683 Imjudo® (tremelimumab-actl) (Intravenous)
VP-90686 Elahere™ (mirvetuximab soravtansine-gynx)
VP-90692 Lunsumio™ (mosunetuzumab-axgb)
VP-90700 Zynyz™ (retifanlimab-dlwr) (Intravenous)
VP-90710 Epkinly™ (epcoritamab-bysp)
VP-90711 Columvi™ (glofitamab-gxbm)
VP-90722 Talvey™ (talquetamab-tgvs)
VP-90724 Elrexfio™ (elranatamab-bcmm)
VP-90735 Loqtorzi™ (toripalimab-tpzi) (Intravenous)
VP-90748 Amtagvi® (lifileucel)
VP-90750 Tevimbra™ (tislelizumab-jsgr)