CommercialPrior AuthMedium impact
Beremagene Geperpavec-svdt (Vyjuvek™)
BCBS Tennessee·TN · Dermatology, Wound Care·Medical Policy
Effective date
Sep 30, 2026
We identified it
Jul 17, 2026
Summary
BlueCross BlueShield of Tennessee is establishing a new coverage policy for Beremagene Geperpavec-svdt (Vyjuvek™), a gene therapy for dystrophic epidermolysis bullosa (DEB) with COL7A1 gene mutations. The policy requires prior authorization, genetic testing confirmation, dermatologist or wound care specialist prescription, and specific wound criteria before coverage is granted for up to 12 months of weekly treatment.
Action Required
By September 30, 2026: Billing team must establish prior authorization workflow for Vyjuvek™ claims. (1) Create prior auth rules in billing system requiring submission of medical records documenting DEB clinical manifestations and COL7A1 genetic test results before claim processing. (2) Update encounter forms and provider education materials to notify dermatology and wound care specialists that this medication requires prior auth and must be prescribed by/in consultation with appropriate specialists. (3) Implement claim validation checks to deny coverage for: non-specialist prescribers, members without genetic testing, wounds with infection/inadequate granulation/prior SCC, recent skin grafts (within 3 months), co-administration with Zevaskyn or Filsuvez, or application to healed wounds. (4) Configure system to limit authorization periods to 12 months. Failure to implement prior auth requirements will result in claim denials and member disputes.