4 tips to streamline your medical oncology and chemotherapy submissions with EviCore

Accurate, complete submissions help EviCore process your requests efficiently and keep your patients’ care on track. Here are four tips to keep in mind:

1. Compassionate use requests for anti-neoplastic drugs

Did you know that you can receive a non-certification letter for compassionate use requests quickly, without needing a peer-to-peer call?

If you’re requesting a drug that is not supported by NCCN guidelines and has no FDA approval, and you need a non-certification letter to pursue compassionate use procurement, indicate that intent in your case submission.

EviCore can provide the necessary letter without the need for you to schedule and conduct a peer-to-peer discussion.

2. Documenting hypersensitivity reactions

When substituting a drug due to a hypersensitivity reaction (for example, Abraxane for paclitaxel, or cisplatin for carboplatin), include the following in your submission:

• Date and severity of the reaction
• Symptoms experienced
• Allergy testing results (e.g., skin test, if performed)
• Whether desensitization was attempted

Thorough hypersensitivity reaction documentation supports faster approval of alternatives.

3. Combination regimen submissions

EviCore reviews anti-neoplastic regimens as listed in NCCN evidence-based guidelines. When submitting a combination regimen containing more than one drug, follow the case build prompts and list all agents, even if you’re unsure whether every drug requires authorization.

A complete regimen listing ensures accurate NCCN guideline alignment and helps avoid delays from incomplete submissions or clarification requests.

4. Biosimilar selection

Many health plans have preferred biosimilar agents. If you select a non-preferred agent, the plan’s preferred alternatives will be presented during the submission process.

Whenever clinically appropriate, choose the health plan’s preferred biosimilar to align with their coverage policy, which will help expedite your request and avoid unnecessary delays.