Carelon Medical Benefits Management’s (Carelon MBM) medical oncology program helps improve care provided to members with cancer. Our medical oncology program leverages our cancer treatment pathways, cancer regimens that optimally balance efficacy and toxicity, to support high-quality, high-value care for members. To further control cost and quality, we simultaneously review complete regimens, including supportive drugs, for alignment with pathways and medical policy.
Our program addresses infused cancer treatment utilization, including chemotherapies, biological therapies, and supportive drugs. It also promotes adherence to our cancer treatment pathways, regimens our panel of academic and community-based oncologists determined to have optimal efficacy and minimal toxicity. Our pathway regimens address the majority of cancer cases in adults, representing 95 percent of cancer medication spending.
This site will help you understand how the Carelon medical oncology program works, and the benefits for both providers and your patients.
Program offerings vary by health plan. We encourage you to review the available resources for each health plan on the Resources page.