Arkansas Blue Cross and Blue Shield knows Medical Oncology is a vital area of medicine for our members who are facing or have experienced a cancer diagnosis. That’s why we are collaborating with Carelon Medical Benefits Management.

Important note: The Carelon Medical Oncology program applies to all Arkansas Blue Cross and Health Advantage members and some (but not all) members of self-funded health plans served by BlueAdvantage Administrators of Arkansas. To identify an included member, just look on the member’s health insurance ID card.

Effective August 1, 2021, oncology providers will use the Carelon Medical Oncology Program for our members who are undergoing cancer treatment.

Carelon programs seek to support clinicians by highlighting evidence-based, high-value care and clinical best practices. Our shared goal is to ensure that our members receive care that is both effective and safe.

Medical oncology program
This new program is a pre-service review program that requires healthcare providers to request prior authorization for therapeutic and supportive medical oncology drugs. It also enables the review of cancer treatment regimens against evidence-based, optimal cancer treatment regimens, while simultaneously ensuring prescribed regimens are aligned with Arkansas Blue Cross and Blue Shield coverage criteria.

Benefits to your practice

• Synchronization with our medical coverage policy. All prescribed regimens are reviewed in real time for benefit coverage.
• Actionable information. When your practice prescribes a cancer treatment regimen for an eligible member and submits it to Carelon for review, the prescribed regimen is compared against a comprehensive library of current, evidence-based Carelon Cancer Treatment Pathways. If the planned regimen is not aligned with a Carelon Pathway, information on evidence-based alternative regimens may be presented for your review. Pathway adherence will be tracked to understand prescribing patterns and regional treatment variation.
• Enhanced reimbursement. By choosing Carelon Cancer Treatment Pathways regimens when clinically appropriate, your practice may be eligible for enhanced reimbursement*.

* Participating providers in Arkansas, California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia or Wisconsin may be eligible for enhanced reimbursement.