Dear MOASC Members,

This email contains two announcements that may be useful to you:  (1) UnitedHealthcare is requiring submission of the KRAS gene report for colorectal cancer patients and (2) we are providing free access to the NCCN Compendium for physicians treating UnitedHealthcare patients.  Details are explained below.

Lee 

KRAS gene requirement for cetuximab and panitumumab in colorectal cancer

Effective April 1, 2009, UnitedHealthcare will require the submission of a pathology report documenting a wild type KRAS gene for coverage of Erbitux® (cetuximab J9055) and Vectibix® (panitumumab J9303) in the treatment of metastatic colorectal cancer.  As always, final coverage is subject to the member’s benefit plan document.

UnitedHealthcare has contracts with two national laboratories (Genzyme Genetics and LabCorp) that provide KRAS testing.   Specimens may be sent directly to these laboratories; claims for members that are paid on a fee for service basis (non capitated) will be paid directly to the laboratories by UnitedHealthcare.  Both laboratories request that a copy of the pathology report be sent with the specimen.   If your local participating laboratory provides this test it will also be covered.
Requirements:

• The submission of a KRAS pathology report is required for members starting therapy using cetuximab or panitumumab after the implementation date.  Only one pathology report per member ID is required.
• Physicians will not be required to submit pathology reports for individuals that were on cetuximab or panitumumab prior to the effective date for the plan's policy.
• The policy applies to those individuals where UnitedHealthcare or one of its affiliated entities is the primary payor.
• Pathology reports are NOT required if UnitedHealthcare or one of its affiliated entities is the secondary payor.

For UnitedHealthcare patients:  Fax a copy of the pathology report to (915) 231-1970 using the KRAS fax coversheet. The coversheet is available at UnitedHealthcareOnline.com >Cancer - Oncology > KRAS > KRAS Fax Coversheet. You may use this process and submit your claims electronically.
For Oxford patients:  Oxford will also require the KRAS pathology report for individuals starting cetuximab and panitumumab therapy 4/1/09.  Providers are required to obtain prior authorization for the use of cetuximab and panitumumab for patients with colorectal cancer.  Prior authorization requirements include the submission of the laboratory report demonstrating the presence of the KRAS wild type gene. Providers should follow  the standard prior authorization process.
Additional information regarding the implementation of this policy for UnitedHealthcare and its entities is available at UnitedHealthcareOnline.com and on the other health plan websites.
Lee Newcomer comments:  UnitedHealthcare had a similar process for the HER2 gene and trastuzumab coverage.  During the two years the edit was active we noted that the billing offices frequently sent the wrong clinical records.   We only need the copy of the laboratory report documenting the KRAS gene type.  Please do not send pathology reports, clinic notes, discharge summaries or other unrelated materials.  It may be beneficial for the clinicians to teach the billing staff what document to send for this review.     
Access to the NCCN Compendium for UnitedHealthcare coverage
The National Comprehensive Cancer Network (NCCN) has announced that effective April 1, 2009 they will require a paid subscription for access to the NCCN Drugs and Biologics Compendium.   As you already know, UnitedHealthcare uses this document as a reference for coverage decisions. 

UHC recognizes the value of the NCCN Drugs and Biologics Compendium in physician practices and has purchased a group rate.  We are pleased to offer FREE access to the NCCN compendium to our UHC participating physicians and their office staff.   

To access the NCCN Drugs and Biologics Compendium under the UHC agreement, you will need to be a registered user of UnitedHealthcareonline.  Once you are logged into our website, proceed to the NCCN Compendium page.  From there, you can log in to www.NCCN.org for free access to the NCCN Drugs and Biologics Compendium. 

If you are not a registered user of UnitedHealthcareonline, go to the New User link in the upper right corner of the home page and register. 

Please share this email with others in your office that accesses the NCCN Compendium.

Lee N. Newcomer, M.D.

UnitedHealthcare Oncology
5901 Lincoln Drive, MN012-S210, Edina, MN 55436

CPT is a registered trademark of the American Medical Association 2009 CPT® CODING CHANGES FOR THE HYDRATION AND THERAPEUTIC, DIAGNOSTIC, AND PROPHYLACTIC DRUG ADMINISTRATION CODES A cross reference between the new 2009 CPT codes and 2008 CPT codes.

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