CommercialPrior AuthHigh impact
Brentuximab Vedotin (Adcetris) (CPB 0823, reviewed 2026-02-24)
Aetna·Oncology, Hematology, Internal Medicine·Medical Policy
Effective date
Feb 24, 2026
We identified it
Aug 12, 2026
Summary
Aetna updated its Clinical Policy Bulletin for Brentuximab Vedotin (Adcetris) effective 2026-02-24, establishing comprehensive coverage criteria for multiple lymphoma types including Hodgkin lymphoma, B-cell lymphomas, primary cutaneous lymphomas, and T-cell lymphomas. All uses require precertification, and site-of-care utilization management policies apply to specialty drug infusions.
Action Required
Before 2026-02-24: (1) Billing team must update prior authorization (precertification) protocols in the billing system to require precertification for ALL Brentuximab Vedotin (Adcetris) claims for Aetna commercial plan members. (2) Configure the system to route precertification requests to Aetna at phone (866) 752-7021 or fax (888) 267-3277, using Statement of Medical Necessity (SMN) forms available through Specialty Pharmacy Precertification. (3) Providers and clinical staff must document specific indication from the approved list (Hodgkin lymphoma, B-cell lymphoma subtypes, primary cutaneous lymphomas, or T-cell lymphoma subtypes) and confirm drug will be used in one of the approved treatment regimens listed in the policy. (4) Add site-of-care verification requirements to the precertification checklist per the Site of Care for Specialty Drug Infusions Utilization Management Policy. (5) Flag any requests for non-covered indications (acute myeloid leukemia, mesothelioma, multiple myeloma, renal cell cancer, small cell lung cancer) for denial. Failure to obtain precertification will result in claim denials; claims without compliant documentation of approved indication and regimen will be denied.