cancer chemotherapy medications covered under the pharmacy benefit and subject to step therapy and/or prior authorization — Highmark

Initial criteria

• The requested product is an FDA-approved federal legend product
• The drug being requested is classified as a cancer chemotherapy medication
• AND the member meets one of the following:
• 1. Treatment of the member’s diagnosis with the requested agent is supported by an NCCN grade 1, 2A, or 2B Category of Evidence and Consensus recommendation per the NCCN Compendia
• OR 2. The prescriber submits appropriate documentation (e.g., peer-reviewed published literature) supporting the use of the requested product for the member’s diagnosis

Approval duration

up to a lifetime authorization