Yescarta (axicabtagene ciloleucel) — Medical Necessity Guidelines
Clinical medical necessity guidelines for authorization and coverage of Yescarta (axicabtagene ciloleucel) for Mass General Brigham Health Plan members across Medicare Advantage, MassHealth/ACO, One Care/SCO, and Commercial plans.
Changed policy format and clarified hierarchy in One Care and SCO variation; simplified criteria including removing indication for marginal zone lymphoma; updated references.
Updated prior authorization table and added variation for One Care and SCO members.
MassHealth variation updated to include new prior authorization process.
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