CommercialPrior AuthMedium impact
Depemokimab-ulaa (Exdensur)
BCBS Tennessee·TN · Allergy & Immunology, Pulmonology, Pediatrics·Medical Policy
Effective date
Dec 1, 2026
We identified it
Sep 10, 2026
Summary
BlueCross BlueShield of Tennessee is adding coverage for Depemokimab-ulaa (Exdensur), a new biologic medication for severe eosinophilic asthma in patients 12 years and older. The policy requires prior authorization, specific clinical criteria (including eosinophil counts or systemic corticosteroid dependence), and documentation of failed previous biologic therapy or high-dose controller medications. This policy takes effect December 1, 2026, but is not yet implemented.
Action Required
By November 1, 2026: (1) Billing team must set up prior authorization rules in the billing system requiring documented evidence of: baseline blood eosinophil count ≥150 cells/mcL OR oral systemic corticosteroid dependence, plus evidence of uncontrolled asthma (≥2 exacerbations in past 12 months, OR ≥1 hospitalization/ED visit, OR poor symptom control) and failure on high-dose ICS plus additional controller medication. (2) Update EMR/encounter forms to capture prescriber specialty (allergist/immunologist or pulmonologist required) and require submission of chart notes showing previous biologic medication trials (drug, dose, frequency, duration). (3) Configure system to deny claims for patients under 12 years old or those with acute bronchospasm/status asthmaticus indications. (4) For continuation of therapy, require documentation of asthma control improvement. (5) Implement rule blocking concurrent use with other biologic or targeted synthetic drugs for same indication. (6) Train billing and prior auth staff on new coverage criteria. Failure to implement prior authorization will result in claim denials for non-compliant submissions.