Medical Policy
Effective Date:01/01/2024 Title:Talvey
Revision Date: Document:BI735:00
CPT Code(s):
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

1)    Talvey (talquetamab-tgvs) requires prior authorization.

2)    Talvey is used to patients with relapsed or refractory multiple myeloma.

3)    Talvey is covered under the medical benefit.

Medical Statement

Initial Approval Criteria

I.             Multiple Myeloma (must meet all):

a.    Diagnosis of MM;

b.    Prescribed by or in consultation with an oncologist or hematologist;

c.    Age > 18 years;

d.    Disease is relapsed or refractory;

e.    Member has received or has documented intolerance to > 4 lines of therapies that include all of the following:

                                  i.    One proteasome inhibitor (e.g. bortezomib, Kyprolis, Ninlaro);

                                ii.    One immunomodulatory drug (e.g. Thalomid, lenalidomide, pomalidomide);

                               iii.    One anti-CD38 monoclonal antibodies (e.g. Darzalex, Sarclisa)

f.     Dosing is consistent with FDA-labeling

 

Approval Duration: 6 months
Limits
Intentially left empty
Reference

1.    Talvey Prescribing Information. Horsham, PA: Janssen Biotech, Inc.; Aug 2023. Available at: www.talvey.com. Accessed August 23, 2023.

2.    National Comprehensive Cancer Network. Multiple Myeloma Version 3.2023. Available at: https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf. Accessed August 23, 2023.

3.    Chari A, Minnema MC, Berdeja JG, et al. Talquetamab, a t-cell–redirecting gprc5d bispecific antibody for multiple myeloma. New England Journal of Medicine. 2022;387(24):2232-2244.
Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.