Oral Anti-Cancer Medications

Oral anti-cancer medications are part of a member's prescription medication benefit and require a brand-name medication copayment. All anti-cancer medications are processed the same as regular prescription medications and the maximum annual benefit applies. To be covered, the oral anti-cancer medication must comply with the following:

• Be prescribed by a physician or other provider licensed to prescribe such medications as anti-cancer chemotherapeutic medications
• Be a Food and Drug Administration (FDA)-approved medication or biological
• Contain the same active ingredients as a non-self-administrable anti-cancer chemotherapeutic medication or biological that is covered when furnished in incident to the physician's service. The oral anti-cancer medication and the non-self-administered medication must have the same chemical generic name as indicated by the FDA's Approved Drug Products (Orange Book), Physician Desk Reference (PDR), or an authoritative medication compendium
• Be a prodrug. A prodrug is an oral medication ingested into the body that metabolizes into the same active ingredient that is found in the non-self-administered version of the medication
• Be medically necessary for the member