Optum Oncology Pathways
Enhance quality and value in cancer care when you treat patients using therapies associated with better clinical outcomes. Optum® Oncology Pathways are detailed, evidence-based regimens selected through rigorous evaluation for specific cancer types and stages. These pathways are currently used in support of 27 million members.*
How cancer pathways are developed
Regimens are based on a comprehensive literature review of all National Comprehensive Cancer Network (NCCN) recommended regimens.
Selection of a regimen is based on efficacy, safety/toxicity and drug cost. (Drug cost is reviewed only when efficacy and safety between regimens are comparable). We also consider health care claims data for the duration of therapy, hospitalization rates and total cost of care.
The Optum Oncology Advisory Committee and disease-specific expert consultants evaluate each pathway. Members of this committee are selected for their clinical expertise to help ensure diverse perspectives. This includes practicing medical oncologists from academic medical centers and community oncology practices who are not employed by Optum Health.
Other program details
- Pathway selection is not required to receive prior authorization approval for therapy.
- Our criteria for coverage determinations for cancer therapies will not change because of this program.
- Optum Oncology Pathways are not a substitute for the experience and judgment of a physician or other health care professional. We don’t make decisions about the kind of care that should or shouldn’t be received. Physicians participating in the program must use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. Care decisions are between the physician and the patient.
Frequently asked questions
*Optum book of business 2023.