Enhancements Coming October 1, 2021

New cancer treatments are entering the market at an unprecedented pace. Since 2018, the U.S. Food and Drug Administration (FDA) has approved more than 136 new cancer indicators, including 53 novel cancer drug entities. The FDA has launched a real-time oncology review program, under which it can review drug data in advance of a formal application, and oncology drugs can gain FDA approval within weeks of the application filing.

Effective October 1, 2021, the 1199SEIU Benefit Funds will make enhancements to our existing eviCore Medical Review Oncology programs. These changes will ensure that providers are guided to the most appropriate National Comprehensive Cancer Network (NCCN)-recommended treatments and are aware of all treatment options, while having administrative burdens reduced through the creation of authorization bundles. These enhancements will include the following:

  • The medical oncology program will have a biosimilar first requirement;
  • Supportive drug authorizations will be reviewed against known risks for the primary chemotherapy regimens consistent with NCCN guidance; and
  • Radiology/chemotherapy bundles for medical oncology treatments will be created.

The Funds recognize there are a growing number of treatment options, combinations and additional lines of therapy that increase the complexity of making evidence-based determinations for treating members. We will continue to look for opportunities to help our providers access the most current and clinically relevant information to ensure that patients achieve optimal outcomes.

Please visit the sites below for educational materials related to each program enhancement and to register for an orientation session. To discuss these changes, call the Provider Relations Call Center at (646) 473-7160.