All PlansCoverageHigh impact
Pembrolizumab (Keytruda®)
BCBS Tennessee·TN · Oncology, Hematology·Medical Policy
Effective date
Jun 30, 2026
We identified it
Jun 17, 2026
Summary
BlueCross BlueShield of Tennessee has issued a comprehensive medical policy for Pembrolizumab (Keytruda®) covering FDA-approved indications across multiple cancer types including melanoma, lung cancer, lymphoma, and others. This policy establishes coverage criteria and approval requirements for this immunotherapy drug but will not take effect until June 30, 2026.
Action Required
Before June 30, 2026: Billing team must review and understand coverage criteria for Pembrolizumab (Keytruda®) across all FDA-approved cancer indications. Update prior authorization workflows to ensure compliance with new policy requirements including PD-L1 testing documentation and specific combination therapy approvals. Providers must ensure proper documentation of tumor markers and staging requirements for coverage determination.