CommercialPrior AuthMedium impact
Ramucirumab (Cyramza®)
BCBS Tennessee·TN · Oncology, Pulmonology, Gastroenterology·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 Ramucirumab (Cyramza®) covering eight cancer indications with specific prior authorization requirements, dosing limits, and continuation criteria. The policy becomes effective September 30, 2026, and requires providers to submit EGFR mutation testing and AFP level results where applicable to obtain prior authorization for treatment.
Action Required
By September 30, 2026: Billing and clinical teams must implement prior authorization workflow for Ramucirumab (Cyramza®) claims. (1) Update billing system to require prior auth submission for all eight covered indications: gastric/GEJ/EGJ adenocarcinoma, NSCLC, colorectal cancer, hepatocellular carcinoma, mesothelioma, and thymic carcinoma. (2) Providers must document and submit EGFR mutation testing results and AFP level results (where applicable per indication) with each prior authorization request. (3) Configure system to enforce 12-month authorization periods for initial approval and reauthorization requests. (4) Update encounter forms and order entry templates to require indication selection and trigger documentation reminders for required lab values. (5) Train providers on continuation criteria: NSCLC has specific T790M testing requirements; all other indications require no evidence of unacceptable toxicity or disease progression. (6) Implement dosing quantity limits in pharmacy system: 8 mg/kg every 2 weeks for colorectal/gastric/HCC; 10 mg/kg every 2-3 weeks depending on indication. Failure to obtain prior authorization will result in claim denials.