CommercialCoverageHigh impact
Chimeric Antigen Receptor T-Cell (CAR-T) Therapy for Candidate Selection 7.02.11
Excellus BlueCross BlueShield·Oncology, Hematology·Transplants
Effective date
Apr 15, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has established new candidate selection criteria for CAR-T therapy coverage effective April 15, 2026. The policy requires extensive pre-treatment documentation including multidisciplinary team evaluation, comprehensive clinical assessments, and specific diagnostic tests before CAR-T therapy will be covered.
Action Required
Before April 15, 2026: Oncology and hematology teams must establish comprehensive CAR-T therapy documentation protocols including multidisciplinary team evaluations, risk-benefit analyses, performance status scores (Karnofsky, PPS, or ECOG), complete lab panels (CBC, metabolic profile, CMV/Hepatitis/HIV serologies), cardiac assessments (EKG, Echo/MUGA), pulmonary assessments (chest X-ray, PFTs for high-risk patients), and age-appropriate screening tests. Update EMR templates to capture all required documentation elements. Ensure Health Plan Pharmacy approval is obtained before proceeding with candidate selection. Failure to provide complete documentation will result in coverage denial.