CommercialPrior AuthMedium impact
Trilaciclib (Cosela) (CPB 0988, reviewed 2026-05-27)
Aetna·Oncology, Pulmonology, Hematology·Medical Policy
Effective date
May 27, 2026
We identified it
Aug 18, 2026
Summary
Aetna has issued a fresh policy (reviewed 2026-05-27) establishing coverage criteria for trilaciclib (Cosela) to reduce chemotherapy-induced myelosuppression in extensive-stage small cell lung cancer patients. All uses require precertification before administration, and the drug is limited to platinum/etoposide or topotecan-containing regimens administered within 4 hours prior to chemotherapy on each treatment day.
Action Required
By 2026-05-27: Billing and authorization teams must implement mandatory precertification for trilaciclib (Cosela) injection. Contact information for precertification: call (866) 752-7021 or fax (888) 267-3277. Update billing system to flag all J1448 claims for prior authorization review before claim submission. Ensure providers verify patient meets all criteria: (1) extensive-stage small cell lung cancer diagnosis (ICD-10 C34.00-C34.92), (2) receiving platinum/etoposide or topotecan regimen, (3) medication administered within 4 hours before chemotherapy on each treatment day, and (4) no concurrent G-CSF or ESA primary prophylaxis during cycle 1. Providers must complete Statement of Medical Necessity (SMN) precertification forms available through Specialty Pharmacy Precertification portal. Claims without prior authorization will be denied. Train front desk and authorization staff on new precertification phone/fax requirements.