Criteria
Coverage is subject to the specific terms of the member's benefit plan.
Teclistamab-cqyv (Tecvayli™) 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
Teclistamab-cqyv (Tecvayli) may be considered medically necessary for treatment of any of the current category 1, 2A, or 2B NCCN recommendations.
The use of Teclistamab-cqyv (Tecvayli) 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
