CommercialPrior AuthMedium impact
Allogeneic Regulatory T Cell Immunotherapy with HSPC and T cells-vldq (Tregzi™)
BCBS Tennessee·TN · Hematology, Oncology, Transplant Surgery·Medical Policy
Effective date
Sep 30, 2026
We identified it
Sep 10, 2026
Summary
BlueCross BlueShield of Tennessee is introducing a new medical policy for Tregzi™ (allogeneic regulatory T cell immunotherapy), a newly FDA-approved drug for preventing chronic graft-versus-host disease in hematological malignancy patients undergoing matched donor hematopoietic stem cell transplantation. The policy establishes strict coverage criteria, requires prior authorization for a single 3-month dose, and will not take effect until September 30, 2026.
Action Required
Before September 30, 2026: Billing team and oncology/hematology providers must prepare for implementation of Tregzi™ prior authorization requirements. (1) Obtain and review the complete Tregzi™ HCPCS code from pharmacy/payer once assigned (not yet listed in policy). (2) Update billing system and prior authorization workflows to require authorization for Tregzi™ claims meeting the specific coverage criteria: patient age ≥18, eligible hematological malignancy in complete remission, planned HLA-matched HSCT with myeloablative regimen, combination use with tacrolimus, HCT-CI ≤4, DRI intermediate/high risk, Karnofsky score ≥70, no prior Tregzi™ treatment, and adequate organ function. (3) Establish internal checklist for providers documenting all required criteria before submission. (4) Train front-desk and clinical staff on coverage limitations (FDA-approved indication only; all other uses are experimental/investigational). (5) Prepare denial management protocols for claims submitted without prior authorization or missing required documentation. (6) Confirm policy implementation date with BlueCross BlueShield of Tennessee on or after 9/30/26 before processing claims.