CommercialCoverageMedium impact
Tarlatamab-dlle (Imdelltra™)
BCBS Tennessee·TN · Oncology·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 Tarlatamab-dlle (Imdelltra™) effective December 1, 2026. The policy covers this medication for adult patients with extensive stage small cell lung cancer (ES-SCLC) with disease progression after platinum-based chemotherapy, with 12-month authorization periods for initial and continued therapy. All other indications are considered experimental/investigational and non-covered.
Action Required
By November 15, 2026: Billing and clinical teams must review and implement this new policy in billing systems and prior authorization workflows. (1) Update prior authorization system to require 12-month authorization for Tarlatamab-dlle when used for ES-SCLC with disease progression on/after platinum-based chemotherapy or for brain metastases in small cell lung cancer. (2) Configure system to deny requests for all other indications as experimental/investigational. (3) Ensure provider documentation requirements capture disease stage (extensive stage), prior platinum-based chemotherapy history, and disease progression status. (4) Train billing, authorization, and clinical staff on coverage criteria and continuation therapy rules (reauthorization granted if no unacceptable toxicity or disease progression). (5) Update claim submission templates and encounter forms to prompt oncology providers to document eligibility criteria. Failure to obtain proper authorization will result in claim denials; claims submitted without meeting coverage criteria will be rejected.