What if a provider uses a chemotherapy drug regimen that is not on the pathway?
Compliance rates for the P4 Pathways Program provide oncologists with the flexibility to take into account specific patient characteristics that may necessitate deviation from the pathway. You can prescribe chemotherapy off the pathway 30% of the time and supportive care 20% of the time, and still be in compliance. This ensures the majority of patients receive the approved pathway regimens, which were agreed to by a Steering Committee panel of BCBST physicians, but that flexibility exists for individual cases. Coverage decisions will remain a responsibility of BCBST.
Related Questions
- If a provider administers 8 gm of a drug that has a NDC and 2 gm were wasted during the process, does the provider bill for 10 gm, or only the 8 gm that was used?
- What happens if a provider bills for a physician-administered drug that is not on the contracted drug list?
- What if the credit card my PrintPOD account uses is lost, stolen or replaced by the card provider?
