Prior authorization for chemotherapy drugs
Learn more about the prior authorization process.
The Optum Care Utilization Management team has partnered with Optum’s Cancer Guidance Program (CGP) to process prior authorization requests for outpatient chemotherapy and cancer supportive drugs.
CGP will process prior authorizations for Optum Care UHC members with a cancer diagnosis in AZ.
In general, the following chemotherapy drugs will require authorization:
- Injectable chemotherapy drugs (J9000 - J9999)
- Leucovorin (J0640) and Levoleucovorin (J0641/J0642)
- Injectable chemotherapy drugs that have a Q code
- Injectable chemotherapy drugs that have not yet received an assigned code and will be billed under a miscellaneous Healthcare Common Procedure Coding System (HCPCS) code will require prior authorization
Supportive therapies such as colony-stimulating factors, bone-modifying agents, and therapies used for prophylaxis or treat of emesis such as:
- Filgrastim, peg-filgrastim and biosimilar agents
- Aprepitant, palonosetron, and combination agents
- Zoledronic acid and denosumab
To submit a request via the CGP portal, please visit mbm.linkplatform.com/home. For more information, please call 1-877-454-8365.