Provider Alerts

For submissions of Prior Authorization Requests Related to Cancer Treatment, the following components must also be provided for review. If any required pieces of information are missing, the request may be deferred for additional information.

Required:

1. Diagnosis (initial date of diagnosis as well if available) 
2. Staging and metastases status
3. Most recent weight/height/BSA
4. Previous treatment history (with dates/duration of therapy if available)
5. Current treatment plan
6. Frequency and dose/dosing regimen (mg/m2 or mg/kg)
7. Intended duration of therapy (including number of cycles)
8. Genetic testing (when relevant)
9. . Rationale for a change in therapy

Optional/Helpful to provide:

1. Chemotherapy order-set
2.  Lab results
3. Intervals of progression of disease
4. Literature for regimen requested 

If you have questions, please contact the HPSJ Pharmacy Department at 209.461.2212. This number leads to a secure voicemail and is reviewed within one business day. You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.