PAs for codes Q2041 Axicabtagene ciloleucel, and Q2042 Tisagenlecleucel, should be sent to Meridian
Date: 06/10/25
The Meridian Medicaid Plan Prior Auth Check Tool has been updated to reflect the noted changes. PAs for codes Q2041 Axicabtagene ciloleucel, and Q2042 Tisagenlecleucel, should be sent to Meridian.
Please note the details of the updated Meridian Preferred Drug List, effective June 10, 2025, for all members.
Impacted Medication | Change |
|---|---|
Q2041 - Axicabtagene ciloleucel (Yescarta®), up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | No longer reviewed by New Century Health. Prior Authorization should be submitted via the secure provider portal or faxed to 833-433-1078. |
Q2042 – Tisagenlecleucel (Kymriah®), up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | No longer reviewed by New Century Health. Prior Authorization should be submitted via the secure provider portal or faxed to 833-433-1078. |
To view all pharmacy PDL updates, visit our Preferred Drug List Updates page.