CommercialPrior AuthMedium impact
Daratumumab and hyaluronidase-fihj (Darzalex Faspro®)
BCBS Tennessee·TN · Oncology, Hematology·Medical Policy
Effective date
Oct 31, 2026
We identified it
Aug 13, 2026
Summary
BlueCross BlueShield of Tennessee has issued a new medical policy for Darzalex Faspro (daratumumab and hyaluronidase-fihj) covering multiple myeloma, light chain amyloidosis, POEMS syndrome, MIDD, and MGRS. The policy establishes prior authorization requirements, specific combination therapy criteria, dosing limits (1800/30,000 mg-units), and reauthorization rules. This policy is NOT effective until 10/31/26 and should not be implemented before that date.
Action Required
Before 10/31/2026: Billing team must configure the prior authorization system to require approval for Darzalex Faspro (HCPCS J9145) claims for Tennessee BlueCross BlueShield members. System must validate: (1) indication matches covered diagnoses (multiple myeloma, light chain amyloidosis, POEMS, MIDD, or MGRS); (2) prescribed combination therapy or single-agent use meets coverage criteria; (3) for t(11:14) translocation-dependent regimens, documentation of translocation testing is submitted; (4) dose does not exceed 1800/30,000 mg-units per subcutaneous administration. For reauthorization requests, verify no unacceptable toxicity or disease progression. For newly diagnosed systemic light chain amyloidosis, enforce 24-month maximum treatment duration. Update prior authorization templates and provider communication materials to reflect these requirements. Do NOT implement before 10/31/26 per policy marking 'Do Not Implement until 10/31/26.' Failure to obtain proper prior authorization after effective date will result in claim denials.