Oncology medical drug management moving to OncoHealth for most members Jan. 1

For dates of service on or after Jan. 1, 2025, OncoHealth^® will manage prior authorizations for medical benefit oncology drugs through the Oncology Value Management program. These drugs are managed by Carelon Medical Benefits Management for dates of service before Jan. 1, 2025.

Important: Blue Cross Blue Shield of Michigan and Blue Care Network will continue to manage prior authorization requests for cellular and gene therapies, such as CAR-T.

Pharmacy benefit oncology drugs will continue to be managed by Blue Cross and BCN for until March 31, 2025. OncoHealth will begin managing these drugs through the Oncology Value Management program for dates of service on or after April 1, 2025. Watch for provider alerts and articles in our provider newsletters about this upcoming change.  

OncoHealth will manage the following:

• Prior authorizations, including reviewing requests for medical necessity, preferred drugs, step therapy requirements and dose optimization
• Site of care transitions from higher- to lower-cost places of service, for Blue Cross and BCN commercial members only

This change will affect the following groups and members:

• Blue Cross commercial
• Fully insured groups and individual members
• Self-funded groups
• Note: The Oncology Value Management program changes won’t apply to Blue Cross commercial UAW Retiree Medical Benefits Trust non-Medicare members or to Blue Cross and Blue Shield Federal Employee Program^® members. Their medical benefit and pharmacy benefit oncology drugs will continue to be managed as they are today.
• Medicare Plus Blue℠ members
• BCN commercial members
• BCN Advantage℠ members

Watch for additional provider alerts and newsletter articles about this change, including how to register for webinars.

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.

OncoHealth is an independent company supporting Blue Cross Blue Shield of Michigan and Blue Care Network by providing cancer support services.