CommercialPrior AuthMedium impact
Datopotamab Deruxtecan-dlnk (Datroway®)
BCBS Tennessee·TN · Oncology, Hematology·Medical Policy
Effective date
Sep 30, 2026
We identified it
Jul 17, 2026
Summary
BlueCross BlueShield of Tennessee is establishing a new prior authorization policy for Datopotamab Deruxtecan-dlnk (Datroway®), a newly FDA-approved cancer treatment. The policy covers HR-positive/HER2-negative metastatic breast cancer and EGFR-mutated NSCLC with specific prior treatment requirements. Authorization is limited to 12 months per approval with reauthorization available for continuation. Policy takes effect September 30, 2026.
Action Required
By September 30, 2026: Billing and prior authorization teams must implement new policy requirements for Datroway (Datopotamab Deruxtecan-dlnk) claims. (1) Update prior authorization system to require submissions for breast cancer (HR+/HER2-) and NSCLC (EGFR+) indications only. (2) Configure system to request required documentation: HER2 status, estrogen/progesterone receptor status, PD-L1 CPS score, BRCA 1/2 testing, and EGFR mutation testing (where applicable). (3) Set authorization duration to 12 months per approval, with renewal reviews for continuation of therapy. (4) Reject requests for triple-negative breast cancer (TNBC) first-line unless PD-L1 CPS <10 and no germline BRCA 1/2 variants; reject breast cancer requests if patient is candidate for Enhertu (fam-trastuzumab deruxtecan-nxki). (5) Flag all other indications as experimental/investigational for denial. (6) Providers: Update order entry systems and treatment protocols to document prior EGFR-directed therapy and platinum-based chemotherapy for NSCLC, and prior endocrine and chemotherapy for breast cancer. Failure to obtain prior authorization before service delivery may result in claim denials and patient billing liability.