Elotuzumab (Empliciti) (CPB 0899, reviewed 2026-03-02)

Effective immediately (2026-03-02): Billing team must implement mandatory precertification requirement for ALL elotuzumab (J9176) claims submitted to Aetna commercial plans. Action items: (1) Update billing system to flag J9176 claims for precertification; (2) Configure system to require Statement of Medical Necessity (SMN) forms for all J9176 requests prior to claim submission; (3) Train billing staff to route all elotuzumab requests to precertification department—call (866) 752-7021 or fax (888) 267-3277; (4) Deny or hold claims for indications listed as experimental/investigational (newly diagnosed MM, smoldering MM, B-cell lymphomas, light chain amyloidosis, primary amyloidosis, SLE, extramedullary myeloma); (5) Verify treatment combinations align with policy (lenalidomide+dex, bortezomib+dex, or pomalidomide+dex for prior treatment MM only); (6) Update encounter templates and provider communications with new coverage criteria. Providers must ensure documentation supports one of the three approved drug combinations and appropriate disease indication. Failure to obtain precertification will result in claim denials.