CommercialCoverageMedium impact
08.02.45b, Telisotuzumab vedotin-tllv (Emrelis™)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Jun 29, 2026
We identified it
Jun 30, 2026
Summary
Policy 08.02.45b establishes medical necessity criteria for Telisotuzumab vedotin-tllv (Emrelis™), a newly approved pharmaceutical agent. This is a pharmacy coverage policy that defines when this drug is medically necessary and eligible for reimbursement under commercial plans. Billing teams must understand and apply these criteria to avoid claim denials.
Action Required
By June 29, 2026: Billing and clinical staff must review the complete medical necessity criteria for Telisotuzumab vedotin-tllv (Emrelis™) in policy 08.02.45b. Update billing system edits and prior authorization workflows to enforce these criteria. Ensure providers understand documentation requirements needed to support medical necessity before dispensing. Train staff on how to identify claims that meet criteria versus those requiring denial. All claims submitted after the effective date without documented medical necessity will be denied.