Narsoplimab-wuug (Yartemlea) (CPB 1099, reviewed 2026-10-16)

Billing and precertification teams must implement the following requirements for Aetna commercial medical plan members: (1) Establish precertification workflow for J1289 (narsoplimab-wuug) by contacting Aetna at (866) 752-7021 or faxing (888) 267-3277 before treatment initiation; (2) Verify all five initial approval criteria are met before submitting authorization requests: member age ≥2 years, confirmed diagnosis with platelet count <150,000/µL, microangiopathic hemolysis evidence (schistocytes, LDH >ULN, and/or haptoglobin <LLN), ADAMTS13 activity ≥10%, and no concurrent use with complement inhibitors (Soliris/J1299, Ultomiris/J1303) or defibrotide; (3) For continuation therapy (reauthorization), document absence of unacceptable toxicity, positive clinical response (improved platelet levels, renal function, normalized LDH/haptoglobin), and continued contraindication with combination therapies; (4) Obtain Statement of Medical Necessity (SMN) precertification forms from Aetna's Specialty Pharmacy Precertification portal before claim submission; (5) Ensure claims are coded with appropriate CPT codes (96365-96368 for infusion), diagnosis codes (M31.11 or T86.00-T86.09/T86.5), and HCPCS code J1289; (6) Flag claims lacking precertification documentation to prevent denials. This policy applies to commercial Aetna members only; Medicare beneficiaries are subject to separate Medicare Part B criteria (not detailed in this bulletin).