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Program changes effective November 1, 2026 for Wellcare By Allwell Medicare Members

Wellcare By Allwell is expanding their collaboration with Evolent as the administrator of the Oncology Quality Management programs for:

• Arkansas
• Missouri
• Texas

​Beginning November 1, 2026, the following services will require a prior authorization, from Evolent, before being administered in either a provider office, outpatient hospital or ambulatory surgical center:  

• Oncology-related infused chemotherapeutic drugs, supportive agents and symptom management medications

• Radiation oncology services requiring authorization:

  • 2D, Electrons (2 dimensional)

  • Brachytherapy

  • Conformal 3D (3 dimensional)

  • IGRT (Image-guided radiation therapy)

  • IMRT (Intensity Modulated Radiation Therapy)

  • Proton Beam Radiation Therapy

  • SBRT (Stereotactic Body Radiation Therapy)

  • SRS (Stereotactic Radiosurgery Therapy)

The Evolent oncology program will apply to the ordering specialties of gynecologic oncology, hematology, medical oncology, neurological oncology, radiation oncology, surgical oncology and urology for the following diagnoses and associated ICD-10 codes for your Medicare members ages 18 years and older: 

• Cancer diagnoses = C00 - D09, D37 - D44, E34.0 

• Hematology diagnosis = D45-D49, D59.10-D59.19, D61.81, D61.82, D63.0, D63.8, D64.2-D64.3, D64.81, D64.89, D64.9, D68.59, D69.3, D69.41, D69.59, D69.6, D69.8, D69.9, D70.1-D70.9, D72.8, D72.9, D73.81, D73.9, D75.1, D75.81, D75.82 

• N&V = R11

What does this mean for you?

Ordering providers will secure prior authorization for oncology services for dates of service on or after November 1, 2026:

• Via the Evolent CarePro portal at evolent.com/provider-portal, select CarePro

• Via telephone

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