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Patient Assistance Programs

• Exelixis Access Services
• Novartis Patient Assistance Foundation
• YesRx

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WPS Oncology Related LCD Updates

Billing and Coding Articles for December 2025

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WPS Recent Oncology Related News

• Hospital & Practitioner PTP Edits
CARC and RARC Remark codes
Final Rule & Fact Sheets
• Telehealth FAQ
• And More

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WPS Educational Offerings

• Live Trainings
• Encore Presentations
• YouTube Videos

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CMS-Medicare

Recent Oncology Related Articles

• Medicare Drug Price Negotiation Program
• 2026 Physician Fee Schedule Final Rule
• Medicare Participation Status
• MLN Matters

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Quality Payment Program (QPP)

• Important Deadlines
• Eligibility Status
• Data Submission Information

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Medically Unlikely Edit (MUE)

• DME Supplier Services
• Facility Outpatient Hospital Services
• Practitioner Services

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Recent RAC Monitor Article

This edition includes articles on

• The Risk of Declining Reimbursement
• UHC Restrictions on Remote Patient Monitoring Payment
• Data Literacy for HIM Leaders: Turning Analytics Into Advocacy
• Phasing out the Inpatient-Only List: Changes Needed for Utilization Review

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BCBSM/BCN

Recent Oncology Related News

• Change to copay & coinsurance for oral chemotherapy
• GM prescription benefits handled by Capital Rx
• Self-funded commercial groups will move to Exclusive Specialty Network
• And More

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BCBSM/BCN

Publications - Important Articles to Note!

• The Record
• BCN Provider News

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Aetna

• December OfficeLink Updates
• Changes to Commercial Drug List
• Changes to National Precertification List
• Aetna Smart Compare

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Health Alliance Plan

• New Online Prior Authorization Platform
• Prior Authorization J9334 and J1305
• Formulary and Prior Authorization Changes
• And More

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Medicaid

• MMP Bulletins 
• Biller Be Aware
• CPT Coding Update

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Molina

Recent Oncology Related News

• Provider Bulletin
• Preferred Drug List
• Billing & Reimbursement Policies
• And More

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Priority Health Update

• 2026 Fee Schedule
• Access Medicaid Provider Manual
• PIP Reports
• And More

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United Healthcare

• Medical & Reimbursement Policy Updates
• Pharmacy & Clinical Updates
• Specialty Drugs & Benefit Updates 

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Recent Oncology Related FDA Approvals and Expanded Indications

Daiichi Sankyo ENHERTU® Plus Pertuzumab
Johnson & Johnson Niraparib and Abiraterone Acetate
Lilly Jaypirca (pirtobrutinib)
AstraZeneca Imfinzi (durvalumab)
Merck KEYTRUDA® (pembrolizumab)
Genmab EPKINLY® (epcoritamab-bysp)
AstraZeneca Koselugo (selumetinib)
Amgen IMDELLTRA® (tarlatamab-dlle)

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None at this time.