CommercialPrior AuthMedium impact
Narsoplimab-wuug (Yartemlea) (CPB 1099, reviewed 27-2026-04)
Aetna·Hematology, Oncology, Transplant Surgery +2 more·Medical Policy
Effective date
Feb 27, 2026
We identified it
Aug 16, 2026
Summary
Aetna has established a new clinical policy (CPB 1099) for Narsoplimab-wuug (Yartemlea), a monoclonal antibody for treating hematopoietic stem cell transplant-associated thrombotic microangiopathy (TA-TMA) in patients age 2+. The policy requires precertification for all claims, strict diagnostic criteria including platelet counts <150,000/µL and microangiopathic hemolysis evidence, ADAMTS13 activity ≥10%, and prohibits concurrent use with complement inhibitors or defibrotide.
Action Required
IMMEDIATELY: (1) Billing team must implement mandatory precertification requirement for all Narsoplimab-wuug (Yartemlea) claims by calling (866) 752-7021 or faxing (888) 267-3277 before claim submission. (2) Update billing system to flag ICD-10 codes M31.11, T86.00-T86.09, and T86.5 as requiring precertification for commercial plans. (3) Create precertification checklist requiring documentation of: patient age ≥2 years, platelet count <150,000/µL, evidence of microangiopathic hemolysis (schistocytes present, LDH >ULN, and/or haptoglobin <LLN), and ADAMTS13 activity ≥10%. (4) Flag claims that list concurrent medications (Soliris/J1299, Ultomiris/J1303, or defibrotide) for denial unless clarified. (5) Providers and billing staff must obtain and attach Statement of Medical Necessity (SMN) form with all precertification requests. (6) For reauthorization requests, ensure documentation demonstrates no unacceptable toxicity and positive therapeutic response (improved platelets, improved renal function, normalized LDH/haptoglobin). Failure to obtain precertification will result in claim denials.