Abecma (idecabtagene vicleucel) IV prior authorization
Prior authorization form and medical necessity criteria for Abecma (idecabtagene vicleucel) IV (HCPCS Q2055) for treatment of relapsed or refractory multiple myeloma, including provider, patient, dosing, quantity limits, and required clinical documentation.
No material changes to clinical coverage or policy criteria.
Coverage Summary
Prior authorization form and medical necessity criteria for Abecma (idecabtagene vicleucel) IV (HCPCS Q2055) for treatment of relapsed or refractory multiple myeloma, including provider, patient, dosing, quantity limits, and required clinical documentation. Authorization is limited to 1 dose of up to 510 million autologous CAR-positive viable T-cells. Documentation must be provided for each checked clinical criterion (lab results, diagnostics, chart notes) or the request may be denied. Coverage stance: Covered with criteria. Administration requires enrollment in the ABECMA REMS program due to risks of cytokine release syndrome (CRS) and neurological toxicities.
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