CommercialPrior AuthMedium impact
Pozelimab-bbfg (Veopoz) (CPB 1043, reviewed 2025-12-09)
Aetna·Gastroenterology, Pediatrics, Internal Medicine +2 more·Medical Policy
Effective date
Nov 13, 2023
We identified it
Aug 13, 2026
Summary
Aetna has established a new clinical policy for pozelimab-bbfg (Veopoz), a complement inhibitor for treating CD55-deficient protein-losing enteropathy (CHAPLE disease). The policy requires precertification for all commercial medical plan members and establishes specific clinical criteria for initial approval and continuation of therapy. Billing teams must implement prior authorization workflows and ensure proper documentation of genetic testing, albumin levels, and clinical symptoms before claims can be processed.
Action Required
IMMEDIATELY (Policy effective 2023-11-13, but recently reviewed 2025-12-09): Billing and authorization team must: (1) Update prior authorization system to REQUIRE precertification for all Aetna commercial medical plan members requesting pozelimab-bbfg (Veopoz) - contact (866) 752-7021 or fax (888) 267-3277; (2) Ensure providers submit Statement of Medical Necessity (SMN) precertification forms available at Specialty Pharmacy Precertification portal; (3) Create authorization checklist requiring verification of: confirmed biallelic CD55 loss-of-function mutation by genotype analysis, serum albumin ≤3.2 g/dL (CPT 82040), and presence of at least one symptom (abdominal pain, diarrhea, peripheral edema, or facial edema) within past 6 months; (4) Flag all claims missing these three criteria as non-approvable; (5) Implement Site of Care Utilization Management Policy for specialty drug infusions per Aetna's separate policy; (6) Train front desk and authorization staff on precertification requirements and contact numbers. Claims submitted without prior authorization will be denied. Update billing software rules to block claim submission until precertification is obtained.