Preauth whole regimen or individual drugs?

Our plan is for me to have a combination of two drugs, and I'm trying to understand how insurance views this so I know what to expect from the preauth so I can plan. My oncologist seems to think that both drugs need to be submitted for preauth together and that insurance will consider the combination. But, my policy and formulary documents don't seem to address the concept of combinations of drugs or regimens. Rather, it seems that the two drugs would be considered separately and if both are preauthorized then there's no problem having them both at the same time.

My policy seems to explicitly cover any drug recognized by the NCCN compendium for my indication. I don't have access to the compendium but I do have the NCCN guidelines for my condition. In the guidelines they list several treatment regimens, some including drug A and others including drug B, but none including both.

Am I right that they will only consider each drug in a vacuum, or could I actually be covered for one or the other but not both?

I did ask customer service about this and I think I got the answer I wanted, but I'm always wary about relying on them for obscure things that are important.

If it matters, the two drugs are bortezomib and venetoclax and the relevant NCCN guidelines are clipped here.

Also: is "previously treated disease" as broad as it sounds? In the myeloma guidelines they refer to "relapsed" or "relapsed/refractory" myeloma which seems more stringent. This will be my third line of treatment, is there any room for them to claim I don't fit the guideline?

Here's the clause from my plan document that refers to NCCN. It's a little weird because it technically appears under the heading "prescription drugs not covered", but aside from that it seems pretty clear:

Prescription Drugs for cancer treatment are covered if the FDA has given approval for at least one indication and the drug is recognized for the treatment of the indication for which the drug has been prescribed in any one of the following established reference compendia: […] (2) the National Comprehensive Cancer Network’s Drugs and Biologics Compendium; […]

Both drugs are listed in the formulary as tier 6 which means:

Non-preferred specialty; May be limited to a specialty pharmacy

Both have flags indicating preauthorization is required, but only bortezomib has the extra flag "specialty medical", probably because it's an injection. I mention this because there are other parts of my plan that refer to "specialty drugs", "specialty pharmacy drugs", or "specialty medical drugs" and it seems really confusing to me whether they're referring only to drugs with the "specialty medical" flag or to all drugs in tiers 5-6.

submitted by /u/uiucengineer
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