CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Amtagvi (lifileucel)
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Dermatology·Medical Policy
Effective date
Jan 20, 2025
We identified it
Jun 20, 2026
Summary
State and School Employees' Health Insurance Plan has established a new policy declaring Amtagvi (lifileucel) not medically necessary for treating unresectable or metastatic melanoma, citing availability of other covered treatment options with equivalent evidence levels. All services related to delivery and administration of this medication will also be considered not medically necessary.
Action Required
Immediately: Billing team must flag Amtagvi (lifileucel) as non-covered for State and School Employees' Health Insurance Plan members with unresectable or metastatic melanoma. Update prior authorization system to automatically deny requests for this medication and related administration services. Inform oncology providers that alternative NCCN-approved treatments must be used for these plan members.