CommercialPrior AuthHigh impact
Carfilzomib (Kyprolis®)
BCBS Tennessee·TN · Oncology, Hematology·Medical Policy
Effective date
Jul 31, 2026
We identified it
Jun 17, 2026
Summary
BlueCross BlueShield of Tennessee has established a new medical policy for Carfilzomib (Kyprolis®) requiring prior authorization for multiple myeloma and other specified conditions. The policy includes detailed coverage criteria, dosing limits, and requires specific documentation including translocation t(11:14) where applicable.
Action Required
By July 31, 2026: Billing team must implement prior authorization requirements for Carfilzomib (Kyprolis®) for BCBS Tennessee members. Update billing system to flag cases requiring prior auth for multiple myeloma, Waldenström macroglobulinemia, systemic light chain amyloidosis, POEMS syndrome, and related conditions. Providers must document translocation t(11:14) where applicable and ensure combination therapies meet specified coverage criteria. Claims will require 12-month authorization periods and compliance with dosing limits (56 mg/m² twice weekly or 70 mg/m² once weekly).