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.

 

Note: Coverage is subject to member's specific benefits. Group specific policies will supersede these policies when applicable. Please refer to member's benefit plan.

Comment on Draft Oncology 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 draft policies.

Comments are accepted 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 by mail or fax

Blue Cross and Blue Shield of Alabama
Attn: Health Management - Medical Policy
P.O. Box 995
Birmingham, AL 35298-0001

Fax: 205-220-0878

Draft Policies

Policy # Policy Title Print View
VP-0001 Abraxane® (paclitaxel protein-bound particles) (Intravenous)
VP-0004 Adcetris® (brentuximab vedotin) (Intravenous)
VP-0014 Bevacizumab: Avastin®; Mvasi™; Zirabev™ (Intravenous)
VP-0036 Emend® (fosaprepitant dimeglumine) (Intravenous)
VP-0038 Erbitux® (cetuximab) (Intravenous)
VP-0043 Faslodex® (fulvestrant) (Intramuscular)
VP-0092 Kadcyla® (ado-trastuzumab emtansine) (Intravenous)
VP-0096 Perjeta® (pertuzumab) (Intravenous)
VP-0109 Rituximab: Rituxan®, Truxima®, Ruxience®, Riabni™ (Intravenous)
VP-0130 Bendamustine (Treanda®; Bendeka™; Belrapzo™) (Intravenous)
VP-0136 Vectibix® (panitumumab) (Intravenous)
VP-0137 Velcade® (bortezomib) (Intravenous/Subcutaneous)
VP-0148 Yervoy™ (ipilimumab) (Intravenous)
VP-0157 Kyprolis® (carfilzomib) (Intravenous)
VP-0161 Zaltrap® (ziv-aflibercept) (Intravenous)
VP-0199 Cyramza™ (ramucirumab) (Intravenous)
VP-0208 Arzerra® (ofatumumab) (Intravenous)
VP-0209 Keytruda® (pembrolizumab) (Intravenous)
VP-0225 Blincyto® (blinatumomab) (Intravenous)
VP-0226 Opdivo® (nivolumab) (Intravenous)
VP-0234 Colony Stimulating Factors – Pegfilgrastim: Neulasta®; Fulphila™; Udenyca™; Ziextenzo™; Nyvepria™ (Subcutaneous)
VP-0235 Colony Stimulating Factors: Filgrastim (Neupogen®); Filgrastim-aafi (Nivestym™); Filgrastim-sndz (Zarxio®); Filgrastim-ayow (Releuko®); Tbo-Filgrastim (Granix®) (Subcutaneous/Intravenous)
VP-0237 Colony Stimulating Factors: Leukine® (sargramostim) (Subcutaneous/Intravenous)
VP-0257 Yondelis® (trabectedin) (Intravenous)
VP-0266 Darzalex™ (daratumumab) (Intravenous)
VP-0267 Portrazza™ (necitumumab) (Intravenous)
VP-0268 Empliciti™ (elotuzumab) (Intravenous)
VP-0278 Tecentriq™ (atezolizumab) (Intravenous)
VP-0295 Bavencio® (avelumab) (Intravenous)
VP-0301 Imfinzi™ (durvalumab) (Intravenous)
VP-0322 Rituxan Hycela™ (rituximab and hyaluronidase human) (Subcutaneous)
VP-0336 Cinvanti™ (aprepitant) (Intravenous)
VP-0351 Bortezomib* (Intravenous Only)
VP-0449 Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk) (Subcutaneous)
VP-0503 Reblozyl® (luspatercept-aamt) (Subcutaneous)
VP-0521 Padcev™ (enfortumab vedotin-ejfv) (Intravenous)
VP-0522 Enhertu® (fam-trastuzumab deruxtecan-nxki) (Intravenous)
VP-0528 Sarclisa® (isatuximab-irfc) (Intravenous)
VP-0532 Trodelvy™ (sacituzumab govitecan-hziy) (Intravenous)
VP-0535 Darzalex Faspro™ (daratumumab and hyaluronidase-fihj) (Subcutaneous)
VP-0550 Zepzelca™ (lurbinectedin) (Intravenous)
VP-0553 Phesgo™ (pertuzumab, trastuzumab and hyaluronidase-zzxf) (Subcutaneous)
VP-0583 Margenza™ (margetuximab-cmkb) (Intravenous)
VP-0599 Jemperli® (dostarlimab-gxly) (Intravenous)
VP-0600 Zynlonta™ (loncastuximab tesirine-lpyl) (Intravenous)
VP-0607 Rybrevant™ (amivantamab-vmjw) (Intravenous)
VP-0624 Tivdak™ (tisotumab vedotin-tftv) (Intravenous)
VP-0658 Kimmtrak® (tebentafusp-tebn) (Intravenous)
VP-0663 Carvykti™ (ciltacabtagene autoleucel) (Intravenous)
VP-0664 Opdualag™ (nivolumab/relatlimab-rmbw) (Intravenous)