Evolent Oncology Program Updates

Date: 07/10/26

Effective 12/01/2026

Wellcare in collaboration with Evolent is implementing updates to how oncology services are reviewed and administered to enhance the member and provider experience. These changes reflect a shared commitment to improving efficiency, reducing administrative burden, and supporting timely, clinically appropriate care decisions.

What’s Changing

Denial Determinations for Oncology Services

Effective 12/1/2026, Evolent will issue denial determinations for oncology authorization requeststhat do not meet clinical criteria.

For requests received prior to 12/1/2026, Evolent will continue to issue Recommended Adverse Determinations (RADs) when clinical criteria are not met Wellcare will provide the final determination of the request.

Please continue to submit grievances and appeals directly to Wellcare.

Pharmacy Benefit (Part D) Scope Update

Effective 12/1/2026, Evolent’s oncology review scope will be limited to medical benefit (Part B) medications only. All pharmacy-dispensed (Part D) drugs must be submitted directly to Wellcare, in accordance with plan guidelines.

Requests received prior to 12/1/2026, will be administered by Evolent under the current process.

For questions or additional information, please contact Provider Relations.