CommercialPrior AuthMedium impact
Isatuximab-irfc (Sarclisa®)
BCBS Tennessee·TN · Oncology, Hematology·Medical Policy
Effective date
Jul 31, 2026
We identified it
Jun 17, 2026
Summary
BlueCross BlueShield of Tennessee is implementing a new medical policy for Isatuximab-irfc (Sarclisa®) for multiple myeloma and related conditions, establishing coverage criteria and prior authorization requirements for 12-month approvals. The policy covers FDA-approved indications and specific compendial uses but requires meeting detailed approval criteria.
Action Required
Before July 31, 2026: Billing team must update prior authorization procedures for Isatuximab-irfc (Sarclisa®) claims. Create documentation checklists to verify patients meet coverage criteria including prior therapy requirements and appropriate combination treatments. Train staff on the 12-month authorization periods and continuation therapy requirements. Update billing system to flag these cases for prior auth review.