Description
Elranatamab-bcmm (Elrexfio) is a bispecific B-cell maturation antigen (BCMA)-directed CD3 T-cell engager that binds BCMA on plasma cells, plasmablasts, and multiple myeloma cells and CD3 on T-cells leading to cytolysis of the BCMA-expressing cells.
Policy Application
All claims submitted for this policy will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.
Criteria
Coverage is subject to the specific terms of the member's benefit plan.
Federal Employee Program members (FEP) should check with their Retail Pharmacy Program to determine if prior approval is required by calling the Retail Pharmacy Program at 1-800-624-5060 (TTY: 1-800-624-5077). FEP members can also obtain the list through the
www.fepblue.org
website.
Elranatamab-bcmm (Elrexfio) may be considered medically necessary for the following:
Multiple Myeloma
-
For the treatment of adult individuals 18 years of age or older with relapsed or refractory multiple myeloma who have received at least four (4) prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent and an anti-CD38 monoclonal antibody;
or
Compendia Sources
Elranatamab-bcmm (Elrexfio) may be considered medically necessary for treatment of any of the current category 1 or 2A NCCN recommendations.
The use of elranatamab-bcmm (Elrexfio)
for all other indications not listed in this policy is considered experimental/investigational and therefore non-covered because the safety and/or effectiveness cannot be established by the available published peer-reviewed literature.
Procedure Code
