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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.

A| B| C| D| E| F| G| H| I| J| K| L| M| N| O| P| Q| R| S| T| U| V| W| X| Y| Z

Aback to topDownload (PDF)
Abraxane (nab paclitaxel)Download (PDF)
Adakveo (crizanlizumab)Download (PDF)
AdcetrisDownload (PDF)
AdstiladrinDownload (PDF)
AdzynmaDownload (PDF)
Alimta and PemfexyDownload (PDF)
Aliqopa (copanlisib)Download (PDF)
AmtagviDownload (PDF)
AnktivaDownload (PDF)
AntiemeticsDownload (PDF)
AphexdaDownload (PDF)
Arranon (nelarabine)Download (PDF)
ArzerraDownload (PDF)
Asparlas (calaspargase pegol-mknl)Download (PDF)
Aucatzyl™ (obecabtagene autoleucel)Download (PDF)
Avastin (bevacizumab) and Biosimilars (Mvasi and Zirabev)Download (PDF)
Bback to topDownload (PDF)
BavencioDownload (PDF)
Beleodaq (belinosat)Download (PDF)
BesponsaDownload (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 topDownload (PDF)
Cablivi (caplacizumab-yhdp)Download (PDF)
Clolar (clofarabine)Download (PDF)
Criteria for evidence-based cancer therapiesDownload (PDF)
ColumviDownload (PDF)
Cosela (trilaciclib)Download (PDF)
Cyramza (ramucirumab)Download (PDF)
Dback to topDownload (PDF)
Danyelza (naxitamab-gqgk)Download (PDF)
Darzalex and Darzalex Faspro (daratumumab)Download (PDF)
Datroway (datopotamab deruxtecan-dlnk)Download (PDF)
Doxil or LipodoxDownload (PDF)
Eback to topDownload (PDF)
ElahereDownload (PDF)
Elrexfio™ (elranatamab-bcmm)Download (PDF)
Elzonris (tagraxofusp)Download (PDF)
Empaveli (pegcetacoplan)Download (PDF)
EmplicitiDownload (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 topDownload (PDF)
FaslodexDownload (PDF)
FolotynDownload (PDF)
Fusilev and Khapzory (levoleucovorin) Download (PDF)
Fyarro (sirolimus)Download (PDF)
Gback to topDownload (PDF)
Gamifant (emapalumab-lzsg)Download (PDF)
GazyvaDownload (PDF)
Generic OncologyDownload (PDF)
Hback to topDownload (PDF)
HalavenDownload (PDF)
Iback to topDownload (PDF)
ImdelltraDownload (PDF)
ImfinziDownload (PDF)
ImjudoDownload (PDF)
ImlygicDownload (PDF)
Intravenous Immune Globulin (Aceniv, Panzyga, Bivigam, Carimune, Cuvitru, Gammagard, Gammaplex, Gamunex, Hiqvia, Gammaked, Octagam, Privigen)Download (PDF)
Iressa (gefitinib)Download (PDF)
IstodaxDownload (PDF)
IxempraDownload (PDF)
Jback to topDownload (PDF)
Jelmyto (mitomycin for pyelocalyceal instillation)Download (PDF)
Jemperli (dostarlimab-gxly)Download (PDF)
JevtanaDownload (PDF)
Kback to topDownload (PDF)
KadcylaDownload (PDF)
Keytruda (pembrolizumab)Download (PDF)
Kimmtrak (tebentafusp-tebn)Download (PDF)
Kyprolis (carfilzomib)Download (PDF)
Lback to topDownload (PDF)
LHRH (Agonists and antagonist)Download (PDF)
Libtayo (cemiplimab-rwlc)Download (PDF)
LoqtorziDownload (PDF)
LumoxitiDownload (PDF)
LunsumioDownload (PDF)
LymphirDownload (PDF)
Mback to topDownload (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)
MylotargDownload (PDF)
Nback to topDownload (PDF)
NplateDownload (PDF)
Oback to topDownload (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 topDownload (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)
PiaskyDownload (PDF)
PoteligeoDownload (PDF)
ProvengeDownload (PDF)
Qback to topDownload (PDF)
Rback to topDownload (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)
RyteloDownload (PDF)
Sback to topDownload (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 topDownload (PDF)
Talvey (talquetamab-tgvs)Download (PDF)
TecelraDownload (PDF)
TecentriqDownload (PDF)
TecvayliDownload (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, TrazimeraDownload (PDF)
Treanda_Bendeka_BelrapzoDownload (PDF)
Trisenox (arsenic trioxide)Download (PDF)
Trodelvy (sacituzumab govitecan-hziy)Download (PDF)
Uback to topDownload (PDF)
Ultomiris (ravulizumab)Download (PDF)
Unituxin (dinutuximab)Download (PDF)
Unloxcyt (cosibelimab-ipdl)Download (PDF)
Vback to topDownload (PDF)
Valstar (valrubicin)Download (PDF)
Vectibix (panitumumab)Download (PDF)
Velcade (bortezomib)Download (PDF)
Vyloy™ (zolbetuximab-clzb)Download (PDF)
VyxeosDownload (PDF)
Wback to topDownload (PDF)
Xback to topDownload (PDF)
Yback to topDownload (PDF)
Yervoy (ipilimumab)Download (PDF)
Yondelis (trabectedin)Download (PDF)
Zback to topDownload (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)