CommercialPrior AuthLow impact
Pivekimab Sunirine-pvzy (Decnupaz™)
BCBS Tennessee·TN · Oncology, Hematology·Medical Policy
Effective date
Sep 30, 2026
We identified it
Sep 10, 2026
Summary
BlueCross BlueShield of Tennessee is establishing a new medical policy for Pivekimab Sunirine-pvzy (Decnupaz™), a newly FDA-approved treatment for blastic plasmacytoid dendritic cell neoplasm (BPDCN) in adult patients. The policy requires prior authorization with confirmed BPDCN diagnosis documentation and covers up to 12 months of single-agent therapy, with reauthorization available if there is no disease progression or unacceptable toxicity.
Action Required
By September 30, 2026: Billing team and prior authorization staff must update system rules and workflows to recognize Decnupaz (Pivekimab Sunirine-pvzy) as a covered medication for BPDCN treatment under BlueCross BlueShield of Tennessee plans. Create a prior authorization template requiring documentation of confirmed BPDCN diagnosis before claim processing. Verify that all claims for this drug include the required medical record documentation supporting BPDCN diagnosis. Configure system to grant initial authorizations for 12 months and flag for reauthorization review if member requests continued treatment. This policy applies exclusively to Tennessee BlueCross BlueShield members; verify plan type before applying requirements. Failure to obtain prior authorization will result in claim denials.