In light of provider feedback we’ve received, effective Jan. 1, 2025, we will no longer require prior authorization for the preparation and administration of the following chimeric antigen receptor (CAR) T-cell therapy medications:
- Abecma (idecabtagene vicleucel)
- Breyanzi (lisocabtagene maraleucel)
- Carvykti (ciltacabtagene autoleucel)
- Kymriah (tisagenlecleucel)
- Tecartus (brexucabtagene autoleucel)
- Yescarta (axicabtagene ciloleucel)
Please note that the medications themselves will continue to require prior authorization. However, prior authorization is no longer required for the harvesting, receipt and preparation, and administration of CAR T-cell therapy drugs (formerly represented by codes 0537T, 0538T, 0539T, and 0540T but replaced as of Jan. 1, 2025 with codes 38225, 38226, 38227, and 38228.)
In addition, we have expanded the initial authorization window for these drugs from three months to six months. We hope this change minimizes the administrative complication associated with needing to re-request a CAR T-cell drug after the initial authorization window runs out.
For prior authorization criteria associated with these CAR T-cell medications, please refer to their respective Medical Drug Medical Necessity Guidelines.