Cancer Guidance Program rounding down dose option

Beginning March 1, 2025, the Optum® Cancer Guidance Program (CGP) will offer providers the option to round down doses of preservative-free, pre-filled injectable chemotherapy drugs to the nearest vial size when the difference between the calculated dose and vial size is not more than 10%.

The CGP manages prior authorization requests for medical and radiopharmaceutical oncology care.

What to expect

Beginning March 1, 2025, a pop-up message will appear in the CGP tool when a provider submits a prior authorization request for an in-scope drug and the dose can be rounded down to the nearest vial size, provided it is not more than 10% of the calculated dose. The message will display the selected dose and the rounded-down dose, asking if you’d like to accept it.

There will be no adverse decisions based on your selection, and you won’t be required to submit any additional information. All requests will continue to be reviewed based on medical necessity of the requested drug/regimen and decision turnaround times won’t be affected.

How to submit prior authorizations using the CGP

To submit a prior authorization request CGP:

• Sign in to the UnitedHealthcare Provider Portal
• From the left-hand tabs, select Prior Authorizations & Notifications
• Next, Create a new request
• Select Oncology and enter the member’s state and plan details
• Finally, you’ll be directed to the Optum website to complete your request

Proven results

The Hematology/Oncology Pharmacy Association standards state that the rounding of biologic and cytotoxic agents within 10% of the ordered dose is recommended based on the “premise that varying the dose amount by +/-10% (or less) will not alter the safety or effectiveness of therapy”.¹ This practice is also endorsed by the National Comprehensive Cancer Network and the American Society of Clinical Oncology.

While advances in cancer care continue to offer patients new and innovative treatment options, care costs can be significant. The dose-rounding option may help reduce injectable chemotherapy drug waste while ensuring clinical efficacy.

Questions? We’re here to help

If you have questions, please call 888-397-8129, 8 a.m.–5 p.m. local time, Monday–Friday.