CommercialPrior AuthMedium impact
Cemiplimab-rwlc (Libtayo®)
BCBS Tennessee·TN · Oncology, Dermatology, Pulmonology·Medical Policy
Effective date
Jul 31, 2026
We identified it
Jun 17, 2026
Summary
BlueCross BlueShield of Tennessee has established a new comprehensive medical policy for Cemiplimab-rwlc (Libtayo®), a cancer immunotherapy drug. The policy covers FDA-approved indications and compendial uses for various cancers including skin cancers, lung cancer, and several other malignancies, with specific prior authorization requirements and coverage criteria for each indication.
Action Required
Before July 31, 2026: Billing team must prepare prior authorization workflows for Cemiplimab-rwlc (Libtayo®) by updating systems to require documentation of PD-L1 tumor expression, molecular testing results for EGFR/ALK/ROS1/BRAF/NTRK/MET/RET, and MSI-H/dMMR/POLE/POLD1 tumor status where applicable. Create checklists for providers to ensure proper documentation of disease staging and treatment history. Oncology staff must familiarize themselves with specific coverage criteria for each cancer type as claims without proper authorization will be denied.