Effective July 1, 2021, we’ll require prior authorization for Breyanzi (Lisocabtagene maraleucel) and Abecma (idecabtagene vicleucel ) or related services, including outpatient or inpatient evaluation and the chimeric antigen receptor T-cell (CAR-T) outpatient or inpatient episode.
This applies to UnitedHealthcare Value & Balance Exchange, Community Plan, Medicare Advantage and commercial plans.
Coverage reviews for Breyazni and Abecmawill be managed by Optum Transplant Resource Services through the same process as other CAR-T therapies.
Health care professionals must contract with Optum Transplant Resource Services to receive prior authorization and bill for CAR-T therapy. Pre-determination reviews for Breyanzi or Abecma prior to this requirement are encouraged and can be requested by contacting Optum Transplant Resource Services at 888-936-7246.
As with all prior authorization requirements, if you provide any CAR-T services without first completing the prior authorization process, the claim may be denied. Members can’t be billed for services denied due to failure to complete the prior authorization process.
Coverage of these products is dependent on state Medicaid program decisions. Certain state Medicaid programs may choose to cover a drug through the state’s fee-for-service program and not the managed care organizations, such as UnitedHealthcare, or they may provide other coverage guidelines and protocols.
Please verify benefits before submitting the prior authorization request or administering the medication.
Contact Optum Transplant Resources Services at 888-936-7246.
Learn how to check requirements, submit new authorizations / notifications, check status, and submit updates by registering for live event or using the Prior Authorization and Notification Interactive User Guide.