CommercialPrior AuthMedium impact
08.02.32, Afamitresgene autoleucel (Tecelra®)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Mar 24, 2025
We identified it
Jun 19, 2026
Summary
This is a new pharmacy policy for Afamitresgene autoleucel (Tecelra®), a CAR-T cell immunotherapy. The policy establishes coverage criteria, prior authorization requirements, and billing guidelines for this new oncology medication effective March 24, 2025. Billing teams must implement prior authorization workflows and ensure claims comply with new coverage determinations.
Action Required
By March 24, 2025: Billing team must implement prior authorization requirements for Tecelra® (afamitresgene autoleucel) claims. Update billing system to flag all Tecelra® prescriptions for prior auth verification before claim submission. Coordinate with oncology providers to obtain prior authorization documentation per policy criteria before treatment initiation. Train billing staff on coverage requirements outlined in policy 08.02.32. Failure to obtain required prior authorization will result in claim denials. Verify patient eligibility and coverage status with payer before each infusion cycle.