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BCBS TennesseeCommercial · Prior Auth · Medical Policy · TN · Oncology, UrologyMedium impact

Leuprolide Mesylate (Camcevi ETM™; Camcevi Kit)

Act
by Nov 15, 2026
Effective date
Dec 1, 2026
Identified
Sep 10, 2026

Summary

BlueCross BlueShield of Tennessee is establishing a new prior authorization policy for Leuprolide Mesylate (Camcevi ETM™; Camcevi Kit) effective December 1, 2026. The policy covers prostate cancer (FDA-approved) and salivary gland tumors (compendial use) with 12-month authorization periods, requiring documentation of androgen receptor (AR) positive status. Initial and continuation authorizations require clinical benefit assessment.

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What to do

by Nov 15, 2026 · 8 steps
01Billing team must implement prior authorization workflow for Leuprolide Mesylate (Camcevi) in the billing system and EMR.
02Update prior auth requirements to flag all Leuprolide Mesylate claims for prostate cancer and salivary gland tumor diagnoses.
03Create prior auth submission checklist requiring androgen receptor (AR) positive test results as mandatory documentation.
04Configure system to grant initial 12-month authorization periods and flag requests for reauthorization when approaching expiration.
05For prostate cancer continuation, system must verify documentation of clinical benefit (serum testosterone <50 ng/dL) and absence of unacceptable toxicity.
06For salivary gland tumor continuation, verify no disease progression or unacceptable toxicity.
07Train billing staff and providers on new requirements.
08Update encounter templates and prior auth request forms to include AR status documentation field.
If missed: Failure to obtain prior authorization will result in claim denials.

Original notice

Leuprolide Mesylate (Camcevi ETM™; Camcevi Kit)
bcbst.com · Always check the source before changing claims.
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BCBS Tennessee policiesTN policy changesOncologyUrology

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