This article is for providers and their office staff who submit requests to Carelon for outpatient cancer care authorizations
Over the next few months, Carelon Medical Benefits Management is updating its provider portal to enable providers to submit more specific information about a member’s length of treatment with Keytruda.
What’s new: Carelon’s system will now require providers to specify both Keytruda treatment duration and any history of its previous use. Physicians and clinicians should document in the medical record the member’s history (if any) with the medication and intended duration for entry into the Carelon authorization system.
Why this is important: Evidence1 supports discontinuing immune checkpoint inhibitors after 24 months for some patients with selected solid tumors.
- Patients have often shown durable responses after stopping therapy without significant survival difference compared to those receiving indefinite treatment.
- This strategy reduces toxicity, treatment fatigue, and financial burdens for our members.
This aligns with National Comprehensive Cancer Network (NCCN) and FDA guidelines and is not a policy update to Blue Cross Blue Shield of Massachusetts’ Quality Care Cancer Program.
Learn more from Carelon: Read the full article on key evidence, patient selection, and post-therapy management strategies in a posting titled, “Optimizing Immunotherapy: A 24-Month Planned Discontinuation Strategy for Advanced Solid Tumors” on the Carelon Provider Connections blog. Under Solution-specific tips you can use, click Medical Oncology Program and scroll to the article.
For information on our Quality Care Cancer Program administered by Carelon, refer to Provider Central’s Cancer Care page.
- National Comprehensive Cancer Network Guidelines, American Society of Clinical Oncologists-endorsed clinical evidence, U.S. Food and Drug Administration labeling.
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