Cigna oncology value-based pathways program
Within the last few decades, the cost of cancer drugs has increased dramatically. The quality of cancer care also varies greatly despite national guidelines. To address these issues, Cigna’s oncology value-based pathways program was created to promote the use of evidence-based, high-value cancer treatment regimens. Pathway regimens are a subset of regimens recommended by the National Comprehensive Cancer Network® (NCCN) that deliver the best clinical outcomes for patients. The program’s goal is to improve the quality of cancer care while controlling costs.
The oncology value-based pathways program is available for specific cancer types and stages, and will be updated based on new clinical evidence, new U.S. Food and Drug Administration (FDA) approvals, or expanded FDA indications.
Pathway regimen development
Pathway regimens are identified by consolidating inputs from value frameworks established by the American Society of Clinical Oncology, NCCN, and the European Society for Medical Oncology. The value frameworks highlight regimens with superior clinical benefit and toxicity profiles. Drug costs are only considered when regimens have comparable clinical benefit and toxicity profiles.
Clinical pathways advisory panel
The advisory panel reviews the clinical appropriateness of selected pathway regimens. The advisory panel consists of board-certified medical oncologists and hematologists from Cigna, eviCore healthcare (eviCore), and community-based oncology practices. Advisors are also affiliated with leading academic medical centers.
How the program works
The pathway regimen will be highlighted during the prior authorization process on the eviCore website (eviCore.com). Providers who request one of the pathway regimens will receive immediate approval.*
If a provider does not request a pathway regimen, a prompt will appear and the provider will have the opportunity to select a pathway regimen. If the provider does not select a pathway regimen, an eviCore medical oncologist may contact the provider to discuss the patient’s condition and the potential clinical benefits of a pathway regimen. The oncology value-based pathways program will not change Cigna's coverage determination criteria as outlined in the applicable coverage policy.
Cigna oncology value-based pathways
See all of our oncology value-based pathways
The oncology value-based pathways program will not apply to all clinical scenarios and is not a substitute for the experience and judgment of the treating provider. The treatment decision remains the responsibility of the treating provider.
*Other policies may apply in select situations.
Feedback Submission:
If you would like to submit information regarding our oncology value-based pathways program, please use our feedback submission form
Your message will be considered during the course of our regularly scheduled review cycle. Because of the large quantity of literature reviewed during each pathway review cycle, we are unable to respond to individual submissions.