Summary
BlueCross BlueShield of Tennessee is establishing a new medical policy for Telisotuzumab vedotin-tllv (Emrelis™), a targeted cancer therapy for advanced non-squamous NSCLC with high c-Met protein overexpression. The policy covers the drug as a single agent for patients with EGFR wild-type tumors who have received prior systemic therapy, requiring prior authorization with specific genetic testing documentation. This policy becomes effective December 1, 2026.
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What to do
Action · 8 steps
01Before December 1, 2026: Billing team and clinical staff must prepare to implement prior authorization requirements for Emrelis™ (telisotuzumab vedotin-tllv) claims.
02Update billing system to flag all Emrelis™ claims for prior authorization.
03Create checklist requiring submission of c-Met protein expression status (≥50% of tumor cells with strong 3+ staining) and EGFR wild-type status before processing.
04Train providers and clinical staff to obtain and document FDA-approved c-Met testing results and EGFR status on all treatment requests.
05Configure system to grant initial authorization for 12 months when criteria are met, and reauthorization for 12 months upon resubmission if no unacceptable toxicity or disease progression documented.
06Add policy reference to prior auth protocols.
07Claims submitted without required testing documentation will be denied.
08Notify oncology providers of testing requirements immediately upon policy activation.
Original notice
Telisotuzumab vedotin-tllv (Emrelis™)
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