Idecabtagene vicleucel and ciltacabtagene autoleucel may be considered medically necessary for individuals with multiple myeloma if they meet criteria 1 through 6:
Are adults (age ≥18) at the time of infusion
Have a documented diagnosis of multiple myeloma
Have relapsed or refractory disease after 4 or more prior lines of therapy, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody (see Policy Guidelines)
Have adequate organ and bone marrow function as determined by the treating oncologist/hematologist
Does not have active infection(s) or inflammatory disorders
Have not received prior chimeric antigen receptor T therapy or any other gene therapy or are being considered for treatment with any other gene therapy.
Idecabtagene vicleucel and ciltacabtagene autoleucel are considered investigational when the above criteria are not met.
Idecabtagene vicleucel and ciltacabtagene autoleucel are considered investigational for all other indications.
