We want to alert you to changes coming for prior authorization and the RegenceRx formulary regarding certain chemotherapy medications.

Bortezomib (Velcade®) or cetuximab (Erbitux®) need prior authorization after February 1, 2010

• Prior authorization will be needed for Regence members starting treatment with bortezomib (Velcade) or cetuximab (Erbitux) after February 1, 2010.  Members treated with either of these medications before February 1, 2010 will not need prior authorization for coverage.
• Prior authorization criteria for bortezomib (Velcade) and cetuximab (Erbitux) and supporting scientific evidence are available in our medication coverage policies at our public website: http://blue.regence.com/policy/medication/contents.html

Review required for chemotherapy needed by Medicare members

• In addition to bortezomib and cetuximab, review will also be needed for bevacizumab (Avastin®), pemetrexed (Alimta®) and rituximab (Rituxan®) for Medicare members.  Brand-name chemotherapy will only be able to be covered if it is administered according to Medicare rules and guidance.
• Specifically, chemotherapy will only be able to be covered for conditions that are acknowledged in national compendia that are recognized by CMS, such as the National Comprehensive Cancer Network (NCCN).  “Off-label” use of chemotherapy that is not recognized by national oncology treatment guidelines will not be eligible for coverage for Regence’s Medicare members and subject to prior authorization.

You can request prior authorization or review on-line or print request forms at: www.regencerx.com/pa

If you have questions or need additional information, please call Pharmacy Customer Service at 1-800-643-5918.