CommercialPrior AuthMedium impact
Narsoplimab-wuug (Yartemlea) (CPB 1099)
Aetna·Oncology, Hematology, Transplant Surgery +1 more·Medical Policy
We identified it
Oct 3, 2026
Summary
Aetna has established a new coverage policy for Narsoplimab-wuug (Yartemlea) for treatment of hematopoietic stem cell transplant-associated thrombotic microangiopathy (TA-TMA) in patients 2 years and older. The policy requires precertification for all claims and specifies strict clinical criteria including platelet count <150,000/μL, evidence of microangiopathic hemolysis, ADAMTS13 activity ≥10%, and prohibits concurrent use with other complement inhibitors or defibrotide.
Action Required
Immediately: Implement mandatory precertification workflow for Narsoplimab-wuug (Yartemlea) in billing system. Billing team must: (1) Route all Yartemlea claims through precertification process before submission; (2) Contact Aetna at (866) 752-7021 or fax (888) 267-3277 to obtain precertification; (3) Verify all clinical criteria are met before processing: patient age ≥2 years, platelet count <150,000/μL, evidence of microangiopathic hemolysis (schistocytes present, LDH >ULN, or haptoglobin <LLN), and ADAMTS13 activity ≥10%; (4) Confirm no concurrent use of complementary inhibitors (Soliris J1299, Ultomiris J1303) or defibrotide; (5) Update billing software to block payment for non-compliant claims. Update claim submission templates to require documentation of precertification approval. Providers must submit Statement of Medical Necessity (SMN) forms per Specialty Pharmacy Precertification requirements. Claims submitted without precertification approval will be denied.