Mogamulizumab-kpkc (Poteligeo®)

By September 15, 2026: Billing and clinical teams must prepare implementation of this new policy. (1) Update prior authorization system to require 12-month prior authorization for Poteligeo® (J9261 or applicable HCPCS code) for mycosis fungoides, Sézary syndrome, and ATLL when criteria are met. (2) Provider education team must notify oncology and hematology providers of new coverage criteria and ATLL combination therapy requirements (single agent vs. CHOP-based regimens). (3) Update billing software rejection logic to deny claims for Poteligeo® used outside the three approved indications or prior to at least one prior systemic therapy for MF/SS. (4) Clinical staff should reference NCCN Guidelines and standard compendia for dosing verification. (5) Document in EMR/EHR any prior systemic therapy history to support medical necessity. Implementation deadline is September 30, 2026 — claims submitted after this date without proper prior authorization will be denied.