CommercialPrior AuthMedium impact
Telisotuzumab vedotin-tllv (Emrelis™)
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 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.
Action Required
Before December 1, 2026: Billing team and clinical staff must prepare to implement prior authorization requirements for Emrelis™ (telisotuzumab vedotin-tllv) claims. Action items: (1) Update billing system to flag all Emrelis™ claims for prior authorization; (2) Create checklist requiring submission of c-Met protein expression status (≥50% of tumor cells with strong 3+ staining) and EGFR wild-type status before processing; (3) Train providers and clinical staff to obtain and document FDA-approved c-Met testing results and EGFR status on all treatment requests; (4) Configure 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; (5) Add policy reference to prior auth protocols. Claims submitted without required testing documentation will be denied. Notify oncology providers of testing requirements immediately upon policy activation.