Breyanzi® (lisocabtagene maraleucel) (Revised)

By May 1, 2026: Billing and clinical teams must implement prior authorization workflow for Breyanzi in the billing system and EMR. (1) Update prior auth submission requirements in billing software to require clinical documentation for each of six indications with specific criteria (disease stage, prior therapy lines, relapsed/refractory status, age ≥18, concurrent lymphodepleting chemotherapy). (2) Create clinical checklist templates in EMR for providers documenting patient eligibility per indication-specific criteria (e.g., CLL/SLL requires 2 prior lines including BTK and BCL-2 inhibitors; Mantle Cell requires BTK inhibitor history). (3) Add exclusion screening fields to prior auth submission forms: prior CD-19 CAR-T, active HBV/HCV, HIV/AIDS, CNS lymphoma, prior allogeneic transplant. (4) Configure system to flag and deny requests meeting any exclusion criteria. (5) Document lifetime dosing limit (one dose maximum per member) in billing system to prevent duplicate approvals. (6) Train billing, prior auth, and clinical staff on six distinct indication pathways with different clinical thresholds. Failure to obtain required prior authorization before treatment will result in claim denials; missing exclusion documentation will delay or deny approval.