Summary: Aetna modified CPB 0981, its coverage policy for belantamab mafodotin-blmf (Blenrep), effective May 8, 2026. Here's what billing teams need to do.
Aetna, a CVS Health company, updated CPB 0981 governing belantamab mafodotin-blmf (Blenrep) coverage for multiple myeloma treatment. The policy doesn't list specific codes in the available data—but if your team bills for Blenrep, this coverage policy change affects your prior authorization workflow, medical necessity documentation, and reimbursement claims starting May 8, 2026. Review your charge capture and authorization processes before that effective date.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna |
| Policy | Belantamab Mafodotin-blmf (Blenrep) — CPB 0981 |
| Policy Code | CPB 0981 |
| Change Type | Modified |
| Effective Date | 2026-05-08 |
| Impact Level | High |
| Specialties Affected | Oncology, Hematology, Infusion/Specialty Pharmacy, Revenue Cycle |
| Key Action | Audit all active Blenrep authorizations and confirm documentation meets updated criteria before May 8, 2026 |
Aetna Belantamab Mafodotin Coverage Criteria and Medical Necessity Requirements 2026
Blenrep has had a complicated regulatory and coverage history, and that context matters for your billing team right now. The FDA withdrew belantamab mafodotin's accelerated approval in 2022 after the DREAMM-3 trial missed its primary endpoint. Then in November 2023, the FDA granted full approval based on the DREAMM-7 and DREAMM-8 trial data—approving it in combination with bortezomib plus dexamethasone and pomalidomide plus dexamethasone for adult patients with relapsed or refractory multiple myeloma.
That full approval is the clinical foundation for Aetna's current CPB 0981 Aetna coverage policy. With a May 8, 2026 modification, Aetna is almost certainly updating this policy to reflect current FDA labeling, updated trial data, and tightened medical necessity criteria. Payers typically use these modifications to narrow the covered populations or add documentation requirements—rarely to expand access without strings attached.
Based on what Aetna has consistently required for high-cost oncology biologics under similar policies, expect medical necessity criteria to require at minimum:
| # | Covered Indication |
|---|---|
| 1 | A confirmed diagnosis of multiple myeloma |
| 2 | Prior treatment with at least one to three prior lines of therapy (consistent with the FDA-approved indication) |
| 3 | Documentation of combination therapy (Blenrep is not approved as a single agent under the current label—it's approved in combination regimens) |
| 4 | Prescriber attestation that the patient has relapsed or refractory disease |
Prior authorization is almost certainly required for Blenrep under this coverage policy. This drug carries a list price well over $10,000 per dose. Aetna does not cover drugs at this price point without a prior auth process, and any claim submitted without a valid authorization number is a claim denial waiting to happen.
If you're not sure how your current authorization workflow aligns with the updated policy, talk to your compliance officer before May 8, 2026.
Aetna Belantamab Mafodotin Exclusions and Non-Covered Indications
Aetna's historical position on belantamab mafodotin during the 2022–2023 withdrawal period treated it as non-covered or experimental. That designation changed with the full FDA approval, but the policy almost certainly retains exclusions for uses outside the approved indication.
Expect the policy to exclude:
Off-label combination regimens. Blenrep's FDA approval covers specific combinations. Using it in an unapproved combination—even with otherwise approved agents—will likely be classified as investigational under this coverage policy.
Monotherapy use. The current FDA approval is for combination regimens. Monotherapy outside of a clinical trial is unlikely to meet Aetna's medical necessity criteria.
Clinical trial overlap. If a patient is enrolled in a trial providing Blenrep at no cost, Aetna will not cover the drug through a commercial claim. Routine care costs in trial settings are a separate question—but the drug itself isn't billable to the payer.
Diagnoses other than multiple myeloma. The approval is indication-specific. Don't attempt to bill Blenrep for other plasma cell disorders or hematologic malignancies without an explicit coverage determination.
Coverage Indications at a Glance
The policy data doesn't include a code-level indication breakdown. Based on the FDA approval and Aetna's standard oncology policy framework, here's the coverage picture:
| Indication | Status | Notes |
|---|---|---|
| Relapsed/refractory multiple myeloma — combination with bortezomib + dexamethasone | Likely Covered | Requires prior authorization and medical necessity documentation; prior lines of therapy must be documented |
| Relapsed/refractory multiple myeloma — combination with pomalidomide + dexamethasone | Likely Covered | Same documentation requirements; confirm specific line-of-therapy threshold in updated CPB 0981 |
| Multiple myeloma — monotherapy | Likely Not Covered | Outside current FDA-approved labeling; likely classified as experimental |
| Off-label combination regimens | Experimental / Not Covered | Aetna follows FDA labeling closely for high-cost oncology agents |
| Non-multiple myeloma hematologic malignancies | Not Covered | No FDA approval for other indications as of 2026 |
| Clinical trial enrollment (drug provided by trial) | Not Covered | Drug cost not billable to payer when trial is the drug provider |
Confirm every row against the actual CPB 0981 language at app.payerpolicy.org/p/aetna/0981 before the May 8, 2026 effective date.
Aetna Belantamab Mafodotin Billing Guidelines and Action Items 2026
Blenrep billing is not routine oncology billing. This drug requires a disciplined process at every touchpoint—from auth to claim submission to remittance review. Here's what your team needs to do before and after May 8, 2026.
| # | Action Item |
|---|---|
| 1 | Pull the full CPB 0981 text now. The available policy data for this change doesn't include the granular criteria. Go directly to app.payerpolicy.org/p/aetna/0981 and read the updated policy. Specifically look for changes to the prior therapy line requirements, the approved combination regimens, and any new documentation mandates. |
| 2 | Audit all active Blenrep authorizations before May 8, 2026. If you have patients currently authorized for Blenrep treatment cycles that extend past the effective date, verify those authorizations are still valid under the updated criteria. Authorizations granted under the previous policy version may not automatically carry forward if criteria changed. |
| 3 | Update your prior authorization templates. Your auth request forms need to capture the combination regimen being used, prior lines of therapy with drug names and dates, relapse or refractory documentation, and performance status. If the updated CPB 0981 adds new documentation fields, your template needs to reflect that before any new auths go out. |
| 4 | Verify your HCPCS coding. The policy data doesn't list specific codes, and Aetna's CPB 0981 doesn't always enumerate them in the publicly available summary. Confirm with your payer contract rep or through a real-time eligibility check which HCPCS code Aetna accepts for belantamab mafodotin-blmf. Blenrep billing typically involves a drug-specific HCPCS code—using the wrong code or billing under an unlisted drug code without payer guidance is a straight path to a claim denial. |
| 5 | Brief your oncology medical director. The combination regimen restrictions matter clinically, not just for billing. If Aetna narrows the covered combinations, your physicians need to know before they prescribe. A prescription for a non-covered combination creates a claim denial you can't easily reverse—and a patient financial liability conversation nobody wants to have after the fact. |
| 6 | Set up remittance monitoring for this CPT/HCPCS code after May 8. Policy modifications that tighten criteria often produce a denial spike in the 30–60 days after the effective date. Flag Blenrep-related remittances for manual review through June 2026 so you catch denial patterns early. |
If your practice or infusion center sees significant Blenrep volume, loop in your billing consultant before the effective date. The financial exposure per claim is high enough that a single documentation misstep costs real money.
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Belantamab Mafodotin Under CPB 0981
The CPB 0981 policy data available for this modification does not list specific CPT, HCPCS, or ICD-10 codes. Do not rely on assumed codes for belantamab mafodotin billing without confirming against the full policy text and your Aetna contract.
What to Confirm Directly
Contact your Aetna provider relations rep or access the full CPB 0981 document to verify:
- The specific HCPCS code Aetna recognizes for belantamab mafodotin-blmf (Blenrep)
- Whether the administration CPT codes for IV infusion are covered under the same authorization
- Which ICD-10-CM diagnosis codes for multiple myeloma (historically in the C90.0x range) are accepted for this drug
Inventing codes here—or billing under a code that isn't mapped to CPB 0981 in Aetna's system—produces a claim denial. Confirm before you bill.
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