Antiemetics for Oncology – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers NK1 receptor antagonists, 5‑HT3 receptor antagonists, and NK1/5‑HT3 combination antiemetics for prevention (and selected 5‑HT3s for treatment of breakthrough) of chemotherapy‑induced nausea and vomiting when use is guideline‑concordant for high/moderate emetogenic regimens and patient CINV risk factors (routine prophylaxis for minimal‑risk regimens is not recommended). Coverage requires oral agents to be administered prior to infusion (not self‑administered at home), prior trial/failure of preferred products or documented intolerance plus physician attestation for non‑preferred agents, documentation of regimen emetogenicity and patient risk factors, adherence to FDA age/labeling limits, and Medicare members must meet applicable NCD/LCD requirements (e.g., NCD 110.18 for oral aprepitant) with Part B injectables documented as furnished “incident to” a physician’s service.

"Prevention of chemotherapy-induced nausea and vomiting (CINV) due to High Emetic Risk parenteral anticancer agents when an NK1 RA (e."