Blincyto® (blinatumomab) (Revised)

Before October 1, 2025: Billing team must establish prior authorization workflow for Blincyto (blinatumomab) claims submitted for Louisiana Medicaid members. Configure billing system to require prior authorization approval before claim submission for all three indications: (1) relapsed/refractory B-cell ALL, (2) B-cell precursor ALL with MRD in remission, and (3) B-cell precursor ALL in consolidation phase. Verify prescriptions include required clinical criteria documentation: Philadelphia chromosome status for ALL diagnosis, minimal residual disease level (≥0.1%) for MRD indication, complete remission status (first or second) for MRD cases, and consolidation phase confirmation for chemotherapy cases. For Ph+ disease, confirm tyrosine kinase inhibitor combination therapy details (bosutinib, dasatinib, imatinib, nilotinib, or ponatinib) are documented. Provider staff must verify patient meets all applicable criteria before submitting authorization requests. Medical reviewers should assess black box warning contraindications and monitor patient history for cytokine release syndrome or neurological toxicity risk factors. Update internal policy documentation and staff training materials. Communicate policy requirements to all oncology providers. Claims submitted without prior authorization will be denied for Louisiana Medicaid members.