About Carelon Medical Benefits Management Cancer Treatment Pathways

Carelon 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.
• Strength of national guideline recommendations
• Cost

Up-to-date

Standards of oncologic care evolve rapidly and keeping pace with change is vital to the health of your patients. That’s why it’s important to know that the Cancer Treatment Pathways identified in our Program are updated through a systematic review of medical evidence, at least quarterly, and more often when new treatments emerge or national guidelines change. Through the rigor of this process, an up-to-date source of Cancer Treatment Pathways is maintained.

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, the treating oncologist may decide that another treatment regimen is best for an individual patient.

Whether a Cancer Treatment Pathway or an alternate regimen is chosen, the Medical Oncology Program supports benefit coverage for all regimens that meet the clinical review criteria of your patient’s health plan.