Blenrep® (belantamab mafodotin-blmf)
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This policy governs prior authorization and coverage stance for the intravenous oncology drug Blenrep for members of Capital Bluecross; it applies to requests for Blenrep and outlines medical necessity and billing information.
No material clinical or coverage changes in this revision.
Coverage and Medical Necessity
Medical Necessity Criteria
Coverage determination for Blenrep
Initial / Original Indication
Initial/Original Indication
Original indication and trial outcomes informing policy
ALL of the following
- Indication: adult patients with relapsed or refractory multiple myeloma who have received at least 4 prior therapies, including an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent.
- Regulatory event: FDA requested withdrawal of U.S. marketing authorization following failure to confirm clinical benefit in the Phase 3 DREAMM-3 trial; accelerated approval was officially withdrawn on February 6, 2023.
Continuation Therapy
Continuation Therapy
Continuation may be allowed under limited circumstances
Provider Actions and Authorization
Prior Authorization Required
Prior authorization is required for Blenrep; submit a prior authorization request per Capital Bluecross policy before initiating therapy.
Continuation / Compassionate Use Exception
Continuation of Blenrep may be considered only for patients previously enrolled in the Blenrep REMS program who elect enrollment in the compassionate use program; document prior REMS enrollment and compassionate use participation.
- Patient previously enrolled in Blenrep REMS
- Patient chooses enrollment in the compassionate use program
Billing Codes
| J9037 | Injection, belantamab mafodontin-blmf, 0.5 mg; 1 billable unit = 0.5 mg |
| 00173-0896-xx | Blenrep 100 mg lyophilized powder in single-dose vial for injection |
Regulatory Notes and Definitions
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