Quality Care Cancer Program

Carelon Medical Benefits Management reviews medical oncology treatment plans for
Blue Cross Blue Shield of Massachusetts commercial and Medicare Advantage members
as part of its Quality Care Cancer Program.


Blue Cross Blue Shield of Massachusetts and Carelon recognize the key role medical oncology practices play in the delivery of high-value, high-quality cancer care. We also recognize the challenges you may face both in keeping current with treatment advances and ensuring cost-effective care for your patients. Together, we are implementing a program to promote evidence-based, high-value care for members undergoing medical oncology treatments. This site was developed to support your oncology practice as you participate in the medical oncology program. For the Radiation Oncology Program, click here.

When your practice prescribes a cancer treatment regimen and submits it for review, it is compared against evidence-based, optimal Cancer Treatment Pathways, while simultaneously ensuring prescribed regimens are aligned with Blue Cross Blue Shield of Massachusetts’ medical policy or CMS Coverage Determinations (applicable for Medicare Advantage members). In cases where the planned regimen is not aligned with an identified Pathway, information on alternatives may be presented but are not required for submission.



Program resources

Visit the resources page to access Pathways details, FAQs, and other resources to support your participation.

Links to Blue Cross Blue Shield of Massachusetts sites and information

Radiation Oncology Program

  • To learn more about the Carelon Radiation Oncology Program, click here

View Pathways and worksheets

Cancer Treatment Pathways Clinical Detail

Our worksheets can help you gather the patient clinical information you’ll need to enter Prior Authorization for intravenous or injectable drugs in the Carelon provider portal