There are some important details to note with this policy:

• If the NCCN compendium lists the drug with a recommendation level 1, 2A or 2B for the condition, the service is eligible for reimbursement based on the member's certificate of coverage.  In general, we do not cover recommendations with Level 3 evidence.
• NCCN updates its compendium on a monthly basis.  New drugs and/or indications for a drug will not be eligible for reimbursement until a recommendation of 1, 2A or 2B is listed in the NCCN compendium.
• This new drug policy requires that you always include the primary cancer diagnosis on the claim.  Claims submitted with only a V58.1 diagnosis code may require additional information prior to a coverage decision.
• The drug policy applies to most benefit plans sponsored or administered by UnitedHealthcare.  It does not apply to members enrolled in benefit plans insured or administered by UnitedHealthcare Plans of the River Valley (f/k/a John Deere Health), Golden Rule, PacifiCare, Neighborhood Health Plan, American Medical Security Life Insurance Co. or our other affiliated companies.  The drug policy also does not apply to members enrolled in government programs such as AmeriChoice, Ovations, SecureHorizons or Medicare Advantage.  This policy will apply to benefit plans insured or administered by Oxford Health Plans beginning May 1, 2008.

Additional communications will be available throughout the year regarding the NCCN compendium as we automate this function.  Our clinical review team will use the NCCN compendium for any current manual reviews.  Please check our Web site frequently for updated details.  If you have any questions, please contact us at unitedoncology@uhc.com.