Evolent (formerly New Century Health) -
Medical Oncology Policies
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 | Download (PDF) |
|---|---|
| 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) |
| B | 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) |
| C | 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) |
| D | 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) |
| E | Download (PDF) |
| Elahere | Download (PDF) |
| Elrexfio™ (elranatamab-bcmm) | Download (PDF) |
| Elzonris (tagraxofusp) | Download (PDF) |
| Empaveli (pegcetacoplan) | Download (PDF) |
| Empliciti | Download (PDF) |
| Emrelis (telisotuzumab vedotin-tllv) | 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) |
| F | Download (PDF) |
| Faslodex | Download (PDF) |
| Folotyn | Download (PDF) |
| Fusilev and Khapzory (levoleucovorin) | Download (PDF) |
| Fyarro (sirolimus) | Download (PDF) |
| G | Download (PDF) |
| Gamifant (emapalumab-lzsg) | Download (PDF) |
| Gazyva | Download (PDF) |
| Generic Oncology | Download (PDF) |
| H | Download (PDF) |
| Halaven | Download (PDF) |
| I | 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) |
| J | Download (PDF) |
| Jelmyto (mitomycin for pyelocalyceal instillation) | Download (PDF) |
| Jemperli (dostarlimab-gxly) | Download (PDF) |
| Jevtana | Download (PDF) |
| K | Download (PDF) |
| Kadcyla | Download (PDF) |
| Keytruda (pembrolizumab) | Download (PDF) |
| Kimmtrak (tebentafusp-tebn) | Download (PDF) |
| Kyprolis (carfilzomib) | Download (PDF) |
| L | 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) |
| Lynozyfic (linvoseltamab-gcpt) | Download (PDF) |
| M | 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) |
| N | Download (PDF) |
| Nplate | Download (PDF) |
| O | 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) |
| P | 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) |
| Q | Download (PDF) |
| R | 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) |
| S | 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) |
| T | 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) |
| U | Download (PDF) |
| Ultomiris (ravulizumab) | Download (PDF) |
| Unituxin (dinutuximab) | Download (PDF) |
| Unloxcyt (cosibelimab-ipdl) | Download (PDF) |
| V | Download (PDF) |
| Valstar (valrubicin) | Download (PDF) |
| Vectibix (panitumumab) | Download (PDF) |
| Velcade (bortezomib) | Download (PDF) |
| Vyloy™ (zolbetuximab-clzb) | Download (PDF) |
| Vyxeos | Download (PDF) |
| W | Download (PDF) |
| X | Download (PDF) |
| Y | Download (PDF) |
| Yervoy (ipilimumab) | Download (PDF) |
| Yondelis (trabectedin) | Download (PDF) |
| Z | 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) |
