CommercialPrior AuthLow impact
Plasminogen, human-tvmh (Ryplazim®)
BCBS Tennessee·TN · 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 Ryplazim® (plasminogen, human-tvmh) for treatment of plasminogen deficiency type 1. The policy requires prior authorization with specific coverage criteria including baseline plasminogen activity levels ≤45% and documented history of lesions, and must be prescribed by or in consultation with a hematologist.
Action Required
Before July 31, 2026: Billing team must update prior authorization protocols for Ryplazim® claims. Ensure providers document baseline plasminogen activity levels ≤45% and history of lesions consistent with plasminogen deficiency type 1. Verify prescriptions are from or in consultation with hematologists. Update staff training on required documentation for initial and continuation requests.