CommercialPrior AuthLow impact
Cablivi (caplacizumab-yhdp)
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Oncology·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBSMS updated their prior authorization policy for Cablivi (caplacizumab-yhdp), a specialized drug for treating acquired thrombotic thrombocytopenic purpura (aTTP). The policy clarifies that drug samples cannot be used to satisfy medical necessity requirements and updates specific criteria for initial requests and renewals, including stricter documentation requirements for aTTP diagnosis.
Action Required
Immediately: Hematologists and specialists treating aTTP patients must ensure prior authorization requests for Cablivi include complete documentation of thrombocytopenia (platelet count <100 x 10⁹/L), microangiopathic hemolytic anemia with schistocytes on blood smear, and ADAMTS13 testing status. Update prior auth workflow to exclude drug samples as qualifying therapy. Billing team must verify all Cablivi requests meet the updated 30-day limit from last plasma exchange.