CommercialPrior AuthMedium impact
Talimogene Laherparepvec (Imlygic™)
BCBS Tennessee·TN · Oncology, Dermatology·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 Talimogene Laherparepvec (Imlygic™) that will establish coverage criteria for melanoma and Merkel cell carcinoma treatments. The policy requires 12-month authorization periods and specific clinical criteria, particularly for Merkel cell carcinoma cases where anti-PD-1/PD-L1 therapy has failed or is contraindicated.
Action Required
By July 31, 2026: Billing team must update prior authorization procedures for Talimogene Laherparepvec (Imlygic™) to require 12-month authorization periods. Providers must document that anti-PD-L1 or anti-PD-1 therapy contraindications or disease progression exist for Merkel cell carcinoma cases, and confirm curative surgery/radiation are not feasible. Update encounter forms to include these documentation requirements for oncology visits involving this drug.