Medical Oncology Value-Based Pathways

This EviCore policy defines value‑based oncology pathways covering a subset of NCCN‑recommended regimens for multiple cancers and treatment settings (the excerpt is a reference list and includes no standalone coverage statements or explicit exclusions). Coverage/use is conditional on specified biomarker and clinical eligibility (e.g., PD‑L1 CPS thresholds, RAS/RAF/BRAF/HER2/dMMR‑MSI‑H/POLE/POLD1/del(17P)/TP53, IPSS‑R), cisplatin/transplant eligibility, prior‑therapy constraints (e.g., “no prior CPI,” prior docetaxel for cabazitaxel), and may require plan‑preferred drug products with documentation of test results and prior treatments.

"References - Multiple Myeloma: First Line: Transplant Ineligible"

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