Radiation Oncologists Hold Follow-up Meeting with BCBSNC on IMRT Policies

Last December, BCBSNC announced that it had revised its medical policies for Intensity Modulated Radiation Therapy (IMRT), and that the new policies would take effect April 1, 2010.  The changes to the medical policies raised concerns among radiation oncologists across the state.

In March, NCMS hosted a meeting with representatives of the radiation oncology community, led by Kevin Roof, MD, of Charlotte, and representatives of BCBSNC to discuss concerns about the new IMRT policies.  During that meeting, Genie Komives, MD, VP, senior medical director, BCBSNC, explained the rationale for the policy changes, which were driven by overuse of the technology for cancers where IMRT has not been shown to be more efficacious than other more traditional, and cost-effective therapies. She also clarified that while IMRT prior authorization requests for cancers other than prostate and head and neck would be denied, those cases can be appealed on an expedited basis and that BCBSNC would fast track those requests for expedited appeals.  Dr. Komives asked that the group meet again at least a month after the policies were in place to review how the appeals process was working and to see if further changes to the BCBSNC policies were warranted.

On May 18th, the group reconvened to discuss the experience with the new IMRT policies.  The radiation oncologists who were familar with the process reported that despite some difficulties with the expedited appeals process in the first few weeks, that in recent weeks, the appeals process appeared to be working more smoothly.  Concerns were raised, however, that not all members of the radiation oncology community were aware of the process that BCBSNC had put into place to address IMRT appeals.  All parties agreed to better publicize the process. In addition, Dr. Komives reported that in response to the information provided by the group and others, anal cancers will be added to the policy criteria as a covered indication but still subject to prior authorization.  She also requested that the group help define certain terms in the policies and reconvene in the next few months to see how the process is working and if any further changes to the policies are warranted.

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