CurrentBlue Cross Blue Shield - MassachusettsPolicy N/A
CAR T-Cell Therapy Services for Multiple Myeloma Prior Authorization
Defines prior authorization documentation and clinical criteria for coverage of BCMA-directed CAR T-cell therapy for members with relapsed or refractory multiple myeloma, including required prior lines of therapy, disease relapse/refractory definitions, organ/infection status, and billing code guidance.
Policy Summary
PayerBlue Cross Blue Shield - Massachusetts
PolicyCAR T-Cell Therapy Services for Multiple Myeloma Prior Authorization
Policy CodePolicy N/A
Change TypeNo material change
Effective DateN/A
Next Review DateN/A
Key ActionSubmit prior authorization and required clinical documentation via Authorization Manager (commercial) or fax out-of-network requests to 888-973-0726; include correct servicing provider and facility NPIs.
SourceLink
POLICY UPDATE CHANGES
No material clinical/coverage changes
3Required prior therapy classes
≥18Minimum age
2+Prior lines of therapy required
Coverage Summary
This policy covers with criteria prior authorization for BCMA‑directed CAR T‑cell therapies for members with relapsed or refractory multiple myeloma. It defines required documentation and clinical criteria that must be met before infusion, including prior lines of therapy, organ and infection status, age, and that the patient has not previously received an FDA‑approved BCMA‑directed CAR T therapy.