Draft Provider-Administered Oncology Policies

To ensure that the development of Blue Advantage oncology policies occurs through an open, collaborative process, we welcome physicians and other providers to submit comments about pharmacy policies that are in the draft stage. We accept comments for 45 days from the posting date listed on the draft policy. Our current draft policies are listed below.

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.


How to Submit Comments

Participating providers can submit scientific, evidence-based information, professional consensus opinions and other information supported by medical literature relevant to draft policies using one of the following methods:

Comment on Draft Medical Policy

Send comments by mail or fax to:

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

Fax: 205-220-0878

Policy # Policy Title Print View
VP-0001 Abraxane® (paclitaxel protein-bound particles) (Intravenous)
VP-0004 Adcetris® (brentuximab vedotin) (Intravenous)
VP-0007 Alimta® (pemetrexed) (Intravenous)
VP-0008 Aloxi® (palonosetron) (Intravenous)
VP-0014 Avastin® (bevacizumab) (Intravenous)
VP-0036 Emend® (fosaprepitant dimeglumine) (Intravenous)
VP-0038 Erbitux® (cetuximab) (Intravenous)
VP-0057 Herceptin® (trastuzumab) (Intravenous)
VP-0071 Immune Globulins (immunoglobulin) (Intravenous)
VP-0092 Kadcyla® (ado-trastuzumab emtansine) (Intravenous)
VP-0096 Perjeta® (pertuzumab) (Intravenous)
VP-0100 Provenge® (sipuleucel-T) (Intravenous)
VP-0109 Rituxan® (rituximab) (Intravenous)
VP-0130 Bendamustine (Treanda®; Bendeka™) (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-0184 Gazyva (obinutuzumab) (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: Neulasta® (pegfilgrastim) (Subcutaneous)
VP-0235 Colony Stimulating Factors: Neupogen® (filgrastim) (Subcutaneous/Intravenous)
VP-0236 Colony Stimulating Factors: Granix® (tbo-filgrastim) (Subcutaneous/Intravenous)
VP-0237 Colony Stimulating Factors: Leukine® (sargramostim) (Subcutaneous/Intravenous)
VP-0245 Colony Stimulating Factors: Zarxio™ (filgrastim-sndz) (Subcutaneous/Intravenous)
VP-0266 Darzalex™ (daratumumab) (Intravenous)
VP-0268 Empliciti™ (elotuzumab) (Intravenous)
VP-0278 Tecentriq™ (atezolizumab) (Intravenous)
VP-0283 Sustol® (granisetron extended-release) (Subcutaneous)
VP-0287 Lartruvo (olaratumab) (Intravenous)
VP-0295 Bavencio® (avelumab) (Intravenous)
VP-0301 Imfinzi™ (durvalumab) (Intravenous)
VP-0317 Besponsa (inotuzumab ozogamicin) (Intravenous)
VP-0319 Kymriah (tisagenlecleucel) (Intravenous)
VP-0320 Mylotarg (gemtuzumab ozogamicin) (Intravenous)
VP-0322 Rituxan Hycela™ (rituximab and hyaluronidase human) (Subcutaneous)
VP-0333 Yescarta™ (axicabtagene ciloleucel) (Intravenous)
VP-0336 Cinvanti™ (aprepitant) (Intravenous)
VP-0351 Bortezomib* (Intravenous Only)
VP-0363 Akynzeo® (fosnetupitant/palonosetron) (Intravenous)
VP-0370 Colony Stimulating Factors: Fulphila™ (pegfilgrastim-jmdb) (Subcutaneous)
VP-0375 Colony Stimulating Factors: Nivestym™ (filgrastim-aafi) (Subcutaneous/Intravenous)
VP-0409 Colony Stimulating Factors: Udenyca™ (pegfilgrastim-cbqv) (Subcutaneous)