Collaborative Cancer Care: How OncoHealth and Excellus BlueCross BlueShield Work Together

Cancer care is personal. Every diagnosis brings its own set of challenges not just for the patient, but for families, providers and employers, too. At Excellus BlueCross BlueShield (BCBS), we understand that managing cancer care requires a team approach. That’s why we support a collaborative model of care, one where pharmacists, oncologists, and hematologists work together to deliver thoughtful, evidence-based treatment that’s personalized to each patient’s journey.

What collaboration looks like

Modern cancer care is never one-size-fits-all. A multidisciplinary team ensures that every decision is guided by clinical expertise, real-world evidence, and the patient’s unique needs.

Through our partnership with OncoHealth, a leading oncology value management organization, we bring even more expertise to the table. When a provider submits a cancer drug request, our team sends it to OncoHealth for clinical review. Their board-certified oncologists and oncology pharmacists evaluate the request using the latest research, treatment guidelines and clinical insights. Based on that review, they make a recommendation. From there, our internal team makes the final decision.

This process ensures every case is looked at through multiple expert lenses, quickly, thoughtfully and with the patient’s best interest in mind. It also removes unnecessary back-and-forth between teams, which helps us deliver timely decisions, something that’s especially critical in cancer care.

It’s this kind of partnership that personalizes care in meaningful ways, and how we help keep costs in check while still delivering high-quality, evidence-based treatment.

Real collaboration. Real impact.

One recent case illustrates the power of this approach.

A patient was diagnosed with stage II bladder cancer and had no prior treatment history. The initial request was for Keytruda® and Padcev® as first-line therapy. After review,

OncoHealth found the regimen was unsupported. The recommended drugs are typically used only after standard therapies fail, and this patient had not yet tried those options.

Instead of approving the request outright, OncoHealth recommended standard-of-care therapy and suggested the provider consider enrolling the patient in a clinical trial. A peer-to-peer review between oncologists took place to discuss alternatives and ensure the best path forward.

Our decision, based on this evidence and collaboration, was to deny the original request. The patient was ultimately treated with platinum-based chemotherapy and radiation, which is the standard protocol for this diagnosis. The result was not just better-aligned care, but a financial impact of $356,000 in avoided costs.

This isn’t about saying “no.” It’s about saying, “let’s make sure this is right.”

Compassion, innovation and a shared commitment

Cancer is complicated, but the way we manage it doesn’t have to be. At Excellus BCBS, we continuously invest in partnerships, technology and programs that make care more connected and personal, like split fill to help minimize unnecessary expenses and reduce medication waste.

The oncology space is positioned to be a significant trend driver for the remaining of 2025. With over 2 million new cancer diagnoses projected, employers should be prepared for the financial and clinical impact of emerging and expanding treatments in this space.

Key trends include:

• Development of targeted therapies
• Advancements in cellular and gene therapies
• Existing therapies gaining expanded indications
• A robust pipeline of new treatments expected

Driving progress through partnership

When it comes to cancer, every choice matters. Through pharmacists, oncologists and health plans like us working together, we ensure those choices are informed, evidence-based and always centered around the person receiving care.

At Excellus BCBS, we know that providing the best possible care requires constant improvement. That’s why we’re proactively developing new programs and partnering with like-minded organizations to bring you the best of what the industry has to offer. We’re driving progress through partnership because when care is collaborative, Everybody Benefits.