Evolent (formerly New Century Health) -
Medical Oncology Policies
Note: Starting Jan. 1, 2024, NCH Management Systems, Inc. d/b/a New Century Health became Evolent Specialty Services, Inc. (Evolent).
Welcome to the Evolent (formerly New Century Health) - Medical Oncology Policies page. Members follow the Medical Policies for the company underwriting or administering their benefit plan. See Frequently Asked Questions: ConnectiCare Oncology Drug Management to learn about the Medical Oncology Program and who these policies apply to.
See also:
Policies are listed in alphabetical order.
Aback to top | Download (PDF) |
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Abraxane (nab paclitaxel) | Download (PDF) |
Adakveo (crizanlizumab) | Download (PDF) |
Adcetris | Download (PDF) |
Adstiladrin | Download (PDF) |
Adzynma | Download (PDF) |
Alimta and Pemfexy | Download (PDF) |
Aliqopa (copanlisib) | Download (PDF) |
Amtagvi | Download (PDF) |
Anktiva | Download (PDF) |
Antiemetics | Download (PDF) |
Aphexda | Download (PDF) |
Arranon (nelarabine) | Download (PDF) |
Arzerra | Download (PDF) |
Asparlas (calaspargase pegol-mknl) | Download (PDF) |
Aucatzyl™ (obecabtagene autoleucel) | Download (PDF) |
Avastin (bevacizumab) and Biosimilars (Mvasi and Zirabev) | Download (PDF) |
Bback to top | Download (PDF) |
Bavencio | Download (PDF) |
Beleodaq (belinosat) | Download (PDF) |
Besponsa | Download (PDF) |
Besremi (ropeginterferon alfa-2b-nijft) | Download (PDF) |
Bizengri (zenocutuzumab-zbco) | Download (PDF) |
Blenrep (belantamab mafodotin-blmf) | Download (PDF) |
Blincyto (blinatumomab) | Download (PDF) |
Bone Modifying Agents (Aredia Zometa Xgeva Prolia) | Download (PDF) |
Cback to top | Download (PDF) |
Cablivi (caplacizumab-yhdp) | Download (PDF) |
Clolar (clofarabine) | Download (PDF) |
Criteria for evidence-based cancer therapies | Download (PDF) |
Columvi | Download (PDF) |
Cosela (trilaciclib) | Download (PDF) |
Cyramza (ramucirumab) | Download (PDF) |
Dback to top | Download (PDF) |
Danyelza (naxitamab-gqgk) | Download (PDF) |
Darzalex and Darzalex Faspro (daratumumab) | Download (PDF) |
Datroway (datopotamab deruxtecan-dlnk) | Download (PDF) |
Doxil or Lipodox | Download (PDF) |
Eback to top | Download (PDF) |
Elahere | Download (PDF) |
Elrexfio™ (elranatamab-bcmm) | Download (PDF) |
Elzonris (tagraxofusp) | Download (PDF) |
Empaveli (pegcetacoplan) | Download (PDF) |
Empliciti | Download (PDF) |
Enhertu (fam-trastuzumab deruxtecan-nxki) | Download (PDF) |
Enjaymo (sutimlimab-jome) | Download (PDF) |
Erbitux (cetuximab) | Download (PDF) |
Erythropoiesis Stimulating Agents (Aranesp, Epogen, Procrit, Retacrit) | Download (PDF) |
Fback to top | Download (PDF) |
Faslodex | Download (PDF) |
Folotyn | Download (PDF) |
Fusilev and Khapzory (levoleucovorin) | Download (PDF) |
Fyarro (sirolimus) | Download (PDF) |
Gback to top | Download (PDF) |
Gamifant (emapalumab-lzsg) | Download (PDF) |
Gazyva | Download (PDF) |
Generic Oncology | Download (PDF) |
Hback to top | Download (PDF) |
Halaven | Download (PDF) |
Iback to top | Download (PDF) |
Imdelltra | Download (PDF) |
Imfinzi | Download (PDF) |
Imjudo | Download (PDF) |
Imlygic | Download (PDF) |
Intravenous Immune Globulin (Aceniv, Panzyga, Bivigam, Carimune, Cuvitru, Gammagard, Gammaplex, Gamunex, Hiqvia, Gammaked, Octagam, Privigen) | Download (PDF) |
Iressa (gefitinib) | Download (PDF) |
Istodax | Download (PDF) |
Ixempra | Download (PDF) |
Jback to top | Download (PDF) |
Jelmyto (mitomycin for pyelocalyceal instillation) | Download (PDF) |
Jemperli (dostarlimab-gxly) | Download (PDF) |
Jevtana | Download (PDF) |
Kback to top | Download (PDF) |
Kadcyla | Download (PDF) |
Keytruda (pembrolizumab) | Download (PDF) |
Kimmtrak (tebentafusp-tebn) | Download (PDF) |
Kyprolis (carfilzomib) | Download (PDF) |
Lback to top | Download (PDF) |
LHRH (Agonists and antagonist) | Download (PDF) |
Libtayo (cemiplimab-rwlc) | Download (PDF) |
Loqtorzi | Download (PDF) |
Lumoxiti | Download (PDF) |
Lunsumio | Download (PDF) |
Lymphir | Download (PDF) |
Mback to top | Download (PDF) |
Margenza (margetuximab-cmkb) | Download (PDF) |
Marqibo (vincristine liposome) | Download (PDF) |
Monjuvi (tafasitamab-cxix) | Download (PDF) |
Mozobil (plerixafor) | Download (PDF) |
Myeloid Growth Factors (Fulphila, Granix, Leukine, Neulasta, Neupogen, Nivestym, Nyvepria, Udenyca and Zarxio) | Download (PDF) |
Mylotarg | Download (PDF) |
Nback to top | Download (PDF) |
Nplate | Download (PDF) |
Oback to top | Download (PDF) |
Oncaspar (pegaspargase) | Download (PDF) |
Onivyde (irinotecan liposome) | Download (PDF) |
Opdivo and Opdivo Qvantiq (nivolumab IV/SC) | Download (PDF) |
Opdualag (nivolumab and relatlimab-rmbw) | Download (PDF) |
Pback to top | Download (PDF) |
Padcev (enfortumab vedotin-ejfv) | Download (PDF) |
Pedmark (sodium thiosulfate) | Download (PDF) |
Pepaxto (melphalan flufenamide) | Download (PDF) |
Photofrin (porfimer) | Download (PDF) |
Polivy (polatuzumab vedotin) | Download (PDF) |
Piasky | Download (PDF) |
Poteligeo | Download (PDF) |
Provenge | Download (PDF) |
Qback to top | Download (PDF) |
Rback to top | Download (PDF) |
Reblozyl (luspatercept-aamt) | Download (PDF) |
Rituximab Products (Riabni, Rituxan Hyclea, Ruxience, Truxima) | Download (PDF) |
Rybrevant (amivantamab-vmjw) | Download (PDF) |
Rylaze (asparaginase Erwinia chrysanthemi and recombinantrywn) | Download (PDF) |
Rytelo | Download (PDF) |
Sback to top | Download (PDF) |
Sarclisa (isatuximab-irfc) | Download (PDF) |
Soliris (eculizumab) | Download (PDF) |
Somatostatin Analog (Sandostatin and Somatuline) | Download (PDF) |
Sylvant (siltuximab) | Download (PDF) |
Synribo (omacetaxine) | Download (PDF) |
Tback to top | Download (PDF) |
Talvey (talquetamab-tgvs) | Download (PDF) |
Tecelra | Download (PDF) |
Tecentriq | Download (PDF) |
Tecvayli | Download (PDF) |
Tepadina (thiotepa) | Download (PDF) |
Tevimbra (tislelizumab-jsgr) | Download (PDF) |
Tivdak (tisotumab vedotin-tftv) | Download (PDF) |
Torisel (temsirolimus) | Download (PDF) |
Trastuzumab Products and Phesgo (pertuzumab trastuzumab and hyaluronidase-zzxf) Herceptin, Herzuma, Kanjinti, Ogivri, Ontruzant, Trazimera | Download (PDF) |
Treanda_Bendeka_Belrapzo | Download (PDF) |
Trisenox (arsenic trioxide) | Download (PDF) |
Trodelvy (sacituzumab govitecan-hziy) | Download (PDF) |
Uback to top | Download (PDF) |
Ultomiris (ravulizumab) | Download (PDF) |
Unituxin (dinutuximab) | Download (PDF) |
Unloxcyt (cosibelimab-ipdl) | Download (PDF) |
Vback to top | Download (PDF) |
Valstar (valrubicin) | Download (PDF) |
Vectibix (panitumumab) | Download (PDF) |
Velcade (bortezomib) | Download (PDF) |
Vyloy™ (zolbetuximab-clzb) | Download (PDF) |
Vyxeos | Download (PDF) |
Wback to top | Download (PDF) |
Xback to top | Download (PDF) |
Yback to top | Download (PDF) |
Yervoy (ipilimumab) | Download (PDF) |
Yondelis (trabectedin) | Download (PDF) |
Zback to top | Download (PDF) |
Zaltrap (ziv-aflibercept) | Download (PDF) |
Zepzelca (lurbinectedin) | Download (PDF) |
Ziihera (zanidatamab-hrii) | Download (PDF) |
Zynlonta (loncastuzimab tesirine-lpyl) | Download (PDF) |
Zynyz (retifanlimab-dlwr) | Download (PDF) |