CommercialPrior AuthMedium impact
Belantamab Mafodotin-blmf (Blenrep) (CPB 0981, reviewed 2026-10-16)
Aetna·Hematology, Oncology, Internal Medicine·Medical Policy
Effective date
Jul 1, 2026
We identified it
Oct 23, 2026
Summary
Aetna implemented a precertification requirement for belantamab mafodotin-blmf (Blenrep) effective July 1, 2026, for all participating providers and members in applicable plan designs. The policy covers multiple myeloma, POEMS syndrome, plasma cell-related MIDD, and plasma cell-related MGRS with specific clinical criteria outlined for initial approval and continuation of therapy.
Action Required
Previously due July 1, 2026 (date passed; verify current applicability): Providers must implement precertification processes for belantamab mafodotin-blmf (Blenrep) for all Aetna participating providers and applicable plan designs. Billing team should update internal workflows to require precertification documentation prior to claim submission for code J9053 and related chemotherapy administration codes (96413-96417) when billed with ICD-10 diagnoses C90.00, C90.01, C90.02, D47.2, or D47.Z9. Precertification requests must be submitted via phone at (866) 752-7021 or fax at (888) 267-3277. Obtain Statement of Medical Necessity (SMN) precertification forms from Specialty Pharmacy Precertification. Verify clinical criteria are met before submission: for multiple myeloma, document prior therapy lines and treatment regimen; for POEMS, MIDD, or MGRS, confirm diagnosis and prior treatment history. Claims submitted without prior precertification authorization will be subject to denial.