Etuvetidigene Autotemcel (Waskyra) (CPB 1097, reviewed 2026-10-05)

Billing team and providers must implement the following requirements for Waskyra (etuvetidigene autotemcel) claims: (1) Obtain precertification from National Medical Excellence (NME) at 877-212-8811 before treatment for all applicable plan designs—claims will be denied without prior authorization; (2) Verify that treatment is administered at an Aetna Institutes GCIT Designated Network facility (unless the member's plan has elected not to require network restriction); (3) Confirm that the prescribing provider is an immunologist, hematologist, or WAS specialist; (4) Validate all clinical approval criteria are met before submission, including patient age (6 months or older), WAS gene mutation confirmation, WASP expression/phenotype assessment, HSCT candidacy, HLA donor status, absence of prior gene therapy, and exclusion of patients with HIV, hepatitis B/C, active TB, malignancy, or other contraindications listed in the policy; (5) Update billing systems and claim submission workflows to reference HCPCS code J3386 (covered if criteria met) and relevant CPT codes for harvesting, preparation, and infusion procedures; (6) Flag claims for manual review if any approval criteria are not met, as these will be considered experimental/investigational and denied. Contact Aetna for clarification on current plan applicability and network facility lists.