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Evolent (formerly New Century Health) - Medical Oncology Policies

Note: Starting Jan. 1, 2024, NCH Management Systems, Inc. d/b/a New Century Health became Evolent Specialty Services, Inc. (Evolent).

Welcome to the Evolent (formerly New Century Health) - Medical Oncology Policies page. Members follow the Medical Policies for the company underwriting or administering their benefit plan. See Frequently Asked Questions: EmblemHealth Oncology Drug Management to learn about the Medical Oncology Program and who these policies apply to.

See also:

You may sort by Date Issued or Title. You may also enter a keyword to search for a policy.

TitleDownload (PDF)
Abirtega/Yonsa/Zytiga (abiraterone acetate)Download (PDF)
Abraxane (nab paclitaxel)Download (PDF)
Adakveo (crizanlizumab)Download (PDF)
AdstiladrinDownload (PDF)
Adcetris (brentuximab vedotin)Download (PDF)
AdzynmaDownload (PDF)
Alimta and PemfexyDownload (PDF)
Aliqopa (copanlisib)Download (PDF)
AmtagviDownload (PDF)
AnktivaDownload (PDF)
AntiemeticsDownload (PDF)
Arranon (nelarabine)Download (PDF)
Arzerra (ofatumumab)Download (PDF)
AphexdaDownload (PDF)
Asparlas (calaspargase pegol-mknl)Download (PDF)
Avastin (bevacizumab) and BiosimilarsDownload (PDF)
Aucatzyl™ (obecabtagene autoleucel)Download (PDF)
Bavencio (avelumab)Download (PDF)
Beleodaq (belinosat)Download (PDF)
Besponsa (inotuzumab ozogamicin)Download (PDF)
Besremi™ (ropeginterferon alfa-2b-nijft)Download (PDF)
Bizengri (zenocutuzumab-zbco)Download (PDF)
Blenrep (belantamab mafodotin-blmf)Download (PDF)
Blincyto (blinatumomab)Download (PDF)
Bone Modifying Agents (Aredia Zometa Xgeva Prolia)Download (PDF)
Cablivi (caplacizumab-yhdp)Download (PDF)
Clolar (clofarabine)Download (PDF)
Criteria for evidence-based cancer therapiesDownload (PDF)
ColumviDownload (PDF)
Cosela (trilaciclib)Download (PDF)
Cyramza (ramucirumab)Download (PDF)
Danyelza (naxitamab-gqgk)Download (PDF)
Darzalex and Darzalex FasproDownload (PDF)
Datroway (datopotamab deruxtecan-dlnk)Download (PDF)
Doxil or Lipodox (liposomal doxorubicin)Download (PDF)
Elahere;Download (PDF)
Elrexfio (elranatamab-bcmm)Download (PDF)
Elzonris (tagraxofusp)Download (PDF)
Empaveli™ (pegcetacoplan)Download (PDF)
Empliciti (elotuzumab)Download (PDF)
Emrelis (telisotuzumab vedotin-tllv)Download (PDF)
Enhertu (fam-trastuzumab deruxtecan-nxki)Download (PDF)
Enjaymo™ (sutimlimab-jome)Download (PDF)
Epkinly (epcoritamab-bysp)Download (PDF)
Erbitux (cetuximab)Download (PDF)
Erythropoiesis Stimulating Agents (Aranesp, Epogen, Procrit, Retacrit)Download (PDF)
Faslodex (fulvestrant)Download (PDF)
Folotyn (pralatrexate)Download (PDF)
Fusilev and Khapzory (levoleucovorin)Download (PDF)
Fyarro™ (intravenous sirolimus)Download (PDF)
Gamifant (emapalumab-lzsg)Download (PDF)
Gazyva (obinutuzumab)Download (PDF)
Generic OncologyDownload (PDF)
Halaven (eribulin)Download (PDF)
Hepzato (melphalan)Download (PDF)
ImdelltraDownload (PDF)
Imfinzi (durvalumab)Download (PDF)
ImjudoDownload (PDF)
Imlygic (Talimogene Laherparepvec)Download (PDF)
Inlexzo (gemcitabine intravesical system)Download (PDF)
Intravenous Immune Globulin (Aceniv, Panzyga, Bivigam, Carimune, Cuvitru, Gammagard, Gammaplex, Gamunex, Hiqvia, Gammaked, Octagam, Privigen)Download (PDF)
Iressa (gefitinib)Download (PDF)
Istodax (romidepsin)Download (PDF)
Ixempra (ixabepilone)Download (PDF)
Jelmyto (mitomycin for pyelocalyceal instillation)Download (PDF)
Jemperli (dostarlimab-gxly)Download (PDF)
Jevtana (cabazitaxel)Download (PDF)
Kadcyla (ado-trastuzumab emtansine)Download (PDF)
Keytruda (pembrolizumab)Download (PDF)
Kimmtrak™ (tebentafusp-tebn)Download (PDF)
Kyprolis (carfilzomib)Download (PDF)
LHRH (Agonists and antagonist)Download (PDF)
Libtayo (cemiplimab-rwlc)Download (PDF)
LoqtorziDownload (PDF)
Lumoxiti (moxetumomab pasudotox)Download (PDF)
LunsumioDownload (PDF)
LymphirDownload (PDF)
Lynozyfic (linvoseltamab-gcpt)Download (PDF)
Margenza (margetuximab-cmkb)Download (PDF)
Marqibo (vincristine liposome)Download (PDF)
Myeloid Growth Factors (Fulphila, Granix, Leukine, Neulasta, Neupogen, Nivestym, Nyvepria, Udenyca and Zarxio)Download (PDF)
Monjuvi (tafasitamab-cxix)Download (PDF)
Mozobil™ (plerixafor)Download (PDF)
Mylotarg (gemtuzumab ozogamicin)Download (PDF)
Nplate (romiplostim)Download (PDF)
Onivyde (irinotecan liposome)Download (PDF)
Oncaspar (pegaspargase)Download (PDF)
Opdualag™ (nivolumab and relatlimab-rmbw)Download (PDF)
Opdivo and Opdivo Qvantiq (nivolumab IV/SC)Download (PDF)
Padcev (enfortumab vedotin-ejfv)Download (PDF)
Pedmark (sodium thiosulfate)Download (PDF)
Pepaxto (melphalan flufenamide)Download (PDF)
Photofrin (porfimer)Download (PDF)
PiaskyDownload (PDF)
Polivy (polatuzumab vedotin)Download (PDF)
Poteligeo (mogamulizumab-kpkc)Download (PDF)
Provenge (sipuleucel-T)Download (PDF)
Reblozyl (luspatercept-aamt)Download (PDF)
Rituximab Products (Riabni, Rituxan Hyclea, Ruxience, Truxima)Download (PDF)
Rybrevant™ (amivantamab-vmjw)Download (PDF)
Rylaze (asparaginase Erwinia chrysanthemi and recombinantrywn)Download (PDF)
RyteloDownload (PDF)
Sarclisa (isatuximab-irfc)Download (PDF)
Soliris (eculizumab)Download (PDF)
Somatostatin AnalogDownload (PDF)
Sylvant (siltuximab)Download (PDF)
Synribo (omacetaxine)Download (PDF)
Talvey (talquetamab-tgvs)Download (PDF)
TecelraDownload (PDF)
Tecentriq (atezolizumab)Download (PDF)
TecvayliDownload (PDF)
Tepadina (thiotepa)Download (PDF)
Tevimbra (tislelizumab-jsgr)Download (PDF)
Torisel (temsirolimus)Download (PDF)
Tivdak™ (tisotumab vedotin-tftv)Download (PDF)
Trastuzumab Products and Phesgo (pertuzumab trastuzumab and hyaluronidase-zzxf) Herceptin, Herzuma, Kanjinti, Ogivri, Ontruzant, TrazimeraDownload (PDF)
Treanda_Bendeka_Belrapzo (bendamustine)Download (PDF)
Trisenox (arsenic trioxide)Download (PDF)
Trodelvy (sacituzumab govitecan-hziy)Download (PDF)
Ultomiris (ravulizumab)Download (PDF)
Unituxin (dinutuximab)Download (PDF)
Unloxcyt (cosibelimab-ipdl)Download (PDF)
Valstar (valrubicin)Download (PDF)
Vectibix (panitumumab)Download (PDF)
Vyloy™ (zolbetuximab-clzb)Download (PDF)
Velcade (bortezomib)Download (PDF)
Vyxeos (daunorubicin and cytarabine liposomal)Download (PDF)
Yervoy (ipilimumab)Download (PDF)
Yondelis (trabectedin)Download (PDF)
Zaltrap (ziv-aflibercept)Download (PDF)
Zepzelca (lurbinectedin)Download (PDF)
Ziihera (zanidatamab-hrii)Download (PDF)
Zusduri (mitomycin intravesical solution)Download (PDF)
Zynlonta (loncastuzimab tesirine-lpyl)Download (PDF)
Zynyz (retifanlimab-dlwr)Download (PDF)

JP66048 08/2025

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