CommercialPrior AuthMedium impact
Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro™)
BCBS Tennessee·TN · Oncology, Pulmonology·Medical Policy
Effective date
Dec 1, 2026
We identified it
Sep 10, 2026
Summary
BlueCross BlueShield of Tennessee is establishing a new medical policy for Rybrevant Faspro (amivantamab and hyaluronidase-lpuj) covering specific EGFR-mutant NSCLC indications. The policy outlines covered indications (FDA-approved and compendial uses), requires prior authorization with genetic testing documentation, and authorizes up to 12 months of treatment per approval. This policy is effective December 1, 2026, and applies to BlueCross BlueShield of Tennessee members only.
Action Required
Before December 1, 2026: (1) Billing team must update prior authorization protocols in billing software to require EGFR mutation test results (exon 19 deletion, exon 21 L858R, or exon 20 insertion) before approving Rybrevant Faspro claims. (2) Providers must document the specific EGFR mutation type and treatment regimen (combination therapy with lazertinib, carboplatin/pemetrexed, or single agent) on all prior authorization requests. (3) Create internal guidance document for front-line staff identifying covered vs. non-covered indications to prevent submission of claims for experimental/investigational uses. (4) Update EMR templates and encounter forms to capture required EGFR testing documentation at time of service. Claims submitted without required genetic testing documentation will be denied. Note: This is a BlueCross BlueShield of Tennessee-specific policy; verify applicability for other payers.