Carelon Medical Benefits Management Cancer Treatment Pathways

Carelon Cancer Treatment Pathways are developed by Carelon oncologists and pharmacists in consultation with a panel of academic and community-based oncologists. Together they apply a rigorous process to evaluate regimens supported by national guidelines such as NCCN guidelines and oncology professional society practice guidelines, and by peer-reviewed, published data. Factors considered include:

• Clinical benefit (efficacy)
• Side-effects (toxicity) – especially those that lead to hospitalizations or impact quality of life
• Lastly, when efficacy and toxicity are equal, cost

Standards of oncologic care evolve rapidly. That’s why it’s important to know that the Carelon Pathways are updated through a systematic review of medical evidence at least quarterly, and more often when new data emerge or national guidelines change.

Putting Your Patients First

We recognize that every patient is unique. While efforts have been made to identify Pathways that offer the best treatment option for most patients, a treating oncologist may decide that another regimen is best for an individual patient. Whether a Carelon Cancer Treatment Pathway or an alternate regimen is chosen, the Medical Oncology Program supports all regimens that meet clinical review criteria under FHCP medical policies.