CommercialPrior AuthMedium impact
Ixabepilone (Ixempra®)
BCBS Tennessee·TN · Oncology·Medical Policy
Effective date
Sep 30, 2026
We identified it
Jul 17, 2026
Summary
BlueCross BlueShield of Tennessee has issued a new medical policy for Ixabepilone (Ixempra®) effective 9/30/2026 establishing coverage criteria for breast cancer treatment. The policy covers FDA-approved uses (combination with capecitabine or single agent) and requires prior authorization with HER2 status documentation. This is a NEW policy establishing initial coverage guidelines, not a change to existing policy.
Action Required
By September 30, 2026: Billing and prior authorization teams must implement this new policy into their systems. (1) Create a new prior authorization rule in the billing/PA system for Ixabepilone (Ixempra®) for breast cancer indications. (2) Configure the system to require submission of HER2 status testing results as mandatory documentation with all prior authorization requests. (3) Ensure prior authorization approvals are limited to 12 months maximum for initial authorization and continuation requests. (4) Train providers and billing staff on the specific coverage criteria: HER2-negative disease as single agent, HER2-positive disease in combination with trastuzumab as 4th line or beyond, and combination with capecitabine when cancer is resistant to anthracycline/taxane therapy with required liver function tests (AST/ALT ≤2.5x ULN, bilirubin ≤1x ULN). (5) Update internal policies and encounter templates to reference this new coverage policy. (6) Note: This policy applies ONLY to BlueCross BlueShield of Tennessee members and does not apply to Medicare, Medicaid, or other commercial plans. Claims submitted without required prior authorization and documentation will be denied.