Tecelra (afamitresgene autoleucel) - MEDICAID - SOUTH CAROLINA

This policy covers Tecelra (afamitresgene autoleucel), a MAGE‑A4–directed autologous T‑cell immunotherapy for adults with unresectable or metastatic synovial sarcoma who have previously received chemotherapy. Coverage is restricted to patients aged ≥18 whose tumors express MAGE‑A4 and who are HLA‑A*02:01/02:02/02:03/02:06 positive, is limited to one lifetime dose, excludes pregnant/breastfeeding patients, and requires Corporate Transplant Department referral and medical director review; other indications lack supporting evidence.

"No documentation requirements are specified in this excerpt."

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