Reviewing the Approval Process of Teclistamab in Multiple Myeloma

During a recent Training Academy hosted by CancerNetwork, experts discussed insurance coverage during treatment with teclistamab-cqyv (Tecvayli) and the resulting adverse effects for patients with multiple myeloma.

The expert panel

Cesar Rodriguez Valdes, MD, on Inpatient Treatments

If we are to start a patient with the step-up [dosing] in the hospital, we get the approval and the hospital [absorbs the] costs of the teclistamab and the tocilizumab [Actemra] and whatever agents are required during the hospital stay. Then we don’t need to worry about how much of a financial burden it’s going to be for the patient, because it’s [simply] a package that the insurance is going to pay the hospital.

Kirollos Hanna, PharmD, BCPS, BCOP, FACC, on Outpatient Treatments

There is some burden on the patient, and we [do talk] to the insurance providers about whether they will cover the hotel stay if [patients are] from out of town…. It’s a daily clinic visit, so there’s usually a co-pay associated with that. There are labs drawn every day, so there’s usually something associated with that. We haven’t done a complete analysis yet from a patient perspective. What we’ve shown is that it reduces the cost of care because, at least from the clinic’s perspective, our cost of doing the work in the clinic is less than the cost of an extended stay in the hospital.

Scott Soefje, PharmD, MBA, BCOP, FCCP, on the Outpatient to Inpatient Process

We try to send them through the fast track. If it comes through remote monitoring, then there’s a way to get them directly admitted to the bed should they need it. We’ve had times where they told them, “Go to the [emergency department]” because they didn’t have a bed, and we had to get them stabilized and then find the bed to put them in.

Frances Bell, NP, on Insurance and Adverse Effect Management

Typically along with the approval for teclistamab, we’re also putting in for insurance authorization and approval for intravenous immunoglobulin [IVIG] for infection prophylaxis. Usually, [infection] starts within the second cycle or by the second cycle with teclistamab. If it’s not approved, we may need to do a peer-to-peer [review] to get it approved. With all of the B-cell maturation antigen agents, IVIG is used to prevent infection and is important.