Amtagvi (lifileucel) - MEDICAID - SOUTH CAROLINA

This policy covers Amtagvi (lifileucel), an autologous tumor‑infiltrating lymphocyte (TIL) adoptive cell therapy, for treatment of unresectable or metastatic melanoma in adults. Coverage is limited to individuals ≥18 years who have progressed on prior PD‑1 blockade (and, if BRAF V600‑mutant, after a BRAF inhibitor ± MEK inhibitor), requires referral to the insurer’s Corporate Transplant Department with medical director review, excludes pregnancy/breastfeeding or desire to conceive, and lists billing codes for informational purposes only.

"HCPCS Code(s): J3490 - Unclassified drugs"

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