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Prior authorization for chemotherapy drugs

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The OptumCare® Utilization Management team has partnered with Authorization Request Coordination (ARC) to process prior authorization requests for chemotherapy drugs. 

ARC is the industry’s first specialty health care authorization management company. Their process is designed to optimize specialty care while minimizing fraud, waste and abuse, and maximizing the efficiency of clinical services.

ARC is currently providing clinical evaluations for Optum® Medical Network on all chemotherapy drug requests. They make sure the regimen and dosage is appropriate for each patient.

Once the case has been reviewed, ARC provides a recommendation to the Optum Medical Network Utilization Management Team (UM). OptumCare UM will then make the final decision to approve or deny the prior authorization request.

It is important to note that there may be drugs that are prescribed during chemotherapy that are not listed on the ARC form. It is critical that you document all drugs given during the therapy/regimen on the form, even if the drug is not listed. 

There are spaces provided on the form for you to list ‘Other’ medications as necessary. This is requested so that ARC has a complete understanding of the patient’s chemotherapy regimen.

If you have any questions about this process, they can be directed to the Optum Medical Network UM team.

1-877-370-2845