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Final Provider-Administered Oncology Drug Policies

The drugs below require that a member’s medical condition meets the policy requirements prior to being given (precertification). 

Providers must submit a request through Magellan Rx for pre-service review in order to be approved. If the provider does not receive approval for precertification, the plan will pay no benefits. 

Precertification for these provider-administered drugs is required when administered in a provider’s office, outpatient facility, or home health setting. 

Note: Coverage is subject to the member's specific benefits. Group-specific benefits will supersede these policies when applicable. Always check eligibility and benefits through your local Blue Plan provider portal or your practice management system to confirm member-specific benefits.

To request a copy of a drug policy, members can contact Customer Service by calling the number on their ID card.


Urgent precertification requests must be called in to MagellanRx at 1-800-424-8270.


Policy # Policy Title Print View
VP-0319 Kymriah (tisagenlecleucel) (Intravenous)
VP-0333 Yescarta™ (axicabtagene ciloleucel) (Intravenous)
VP-0558 Tecartus™ (brexucabtagene autoleucel) (Intravenous)
VP-0590 Breyanzi® (lisocabtagene maraleucel) (Intravenous)
VP-0598 Abecma® (idecabtagene vicleucel) (Intravenous)
VP-0663 Carvykti™ (ciltacabtagene autoleucel) (Intravenous)
VP-0691 Adstiladrin® (nadofaragene firadenovec-vncg) (Intravesical)
VP-0748 Amtagvi® (lifileucel)