Tecelra (afamitresgene autoleucel) - Medicare Advantage

This policy covers Tecelra (afamitresgene autoleucel), a single‑dose autologous MAGE‑A4–targeted T‑cell therapy, for treatment of adults with unresectable or metastatic synovial sarcoma. Coverage is limited to patients ≥18 years who have received prior chemotherapy, are HLA‑A*02:01, A*02:02, A*02:03, or A*02:06 positive and whose tumors express MAGE‑A4; requests require medical director review/prior authorization, use outside this indication or without the required biomarkers is not covered, and the approval was granted under accelerated approval pending confirmatory data.

"Medical record documentation confirming diagnosis of unresectable or metastatic synovial sarcoma."

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