Talvey (talquetamab) (Revised)

REQUIREMENTS: Immediately: Billing team must implement prior authorization requirement for all Talvey (talquetamab) claims for Medicare and Medicaid members in Florida, Kentucky, and South Carolina. Before submitting claims: 1. Verify the patient has a diagnosis of relapsed/refractory multiple myeloma (ICD-10: C90.1x series) 2. Confirm documentation shows at least four prior lines of therapy including: a proteasome inhibitor (e.g., bortezomib), an immunomodulatory agent (e.g., lenalidomide), and an anti-CD38 monoclonal antibody (e.g., daratumumab) 3. Confirm Talvey is being used as a single agent (not in combination with other agents) 4. Flag for denial any claims where patient has experienced disease progression while on Talvey 5. Update claim submission templates in billing software to require prior authorization flag for all Talvey requests 6. Providers must submit clinical documentation supporting all four criteria before billing 7. No claims for experimental/investigational indications outside CMS-recognized compendia will be approved Consequences of inaction: All Talvey claims lacking prior authorization will be denied. Claims lacking required clinical documentation will be rejected. Claims for patients with disease progression on Talvey will be denied.