Bendamustine Products (CPB 0875, reviewed 2026-02-24)

IMMEDIATE ACTION REQUIRED: By 2026-02-24, implement the following: (1) Billing team must establish precertification requirement for ALL bendamustine products (Belrapzo, Bendeka, Treanda, Vivimusta, generic) in billing system before claims submission. (2) Route all bendamustine authorization requests to Aetna at (866) 752-7021 or fax (888) 267-3277 using Statement of Medical Necessity forms available at Specialty Pharmacy Precertification portal. (3) Update provider encounter templates to require documentation of: specific lymphoma/leukemia diagnosis, prior therapy history, combination therapy partners (e.g., rituximab, polatuzumab vedotin-piiq), and treatment line (initial vs. subsequent). (4) Configure system to DENY claims for bendamustine used for non-covered indications including: acute myeloid leukemia, breast cancer, colorectal cancer, lung cancer, melanoma, myelodysplastic syndrome, or any indication not explicitly listed in Section I of policy. (5) Verify dosing accuracy: CLL patients receive 100 mg/m² on Days 1-2 of 28-day cycles (up to 6 cycles); B-cell NHL patients receive 120 mg/m² on Days 1-2 of 21-day cycles (up to 8 cycles). (6) Oncology staff must verify combination therapy partners are also authorized before submitting bendamustine claim. Failure to obtain precertification will result in automatic claim denials. Contact Aetna Specialty Pharmacy Precertification for all SMN forms.