By Counterforce Health Team in Blenrep (belantamab mafodotin) —

How to Get Blenrep (belantamab mafodotin) Covered by Cigna in Texas: Forms, Appeals, and Current Access Options

Answer Box: Getting Blenrep (belantamab mafodotin) Covered by Cigna in Texas

Current Status: Blenrep is not commercially available in the US (withdrawn 2022; FDA resubmission pending October 2025). For Texas patients with Cigna coverage, access is limited to clinical trials or expanded access programs.

If pursuing coverage: Submit Cigna's Blenrep PA form documenting 4+ prior multiple myeloma therapies. For denials, use Cigna's internal appeal process, then Texas's Independent Review Organization (IRO) system within 4 months of final denial.

First step today: Contact your oncologist to explore clinical trials at ClinicalTrials.gov or discuss alternative BCMA-targeted therapies like CAR-T or bispecifics covered by Cigna.

Table of Contents

  1. Current Blenrep Availability Status
  2. Cigna Prior Authorization Requirements
  3. Forms and Submission Process
  4. Appeals Process for Texas Patients
  5. Alternative Coverage Options
  6. Clinical Trial and Expanded Access
  7. Common Questions
  8. Getting Help in Texas

Current Blenrep Availability Status

Blenrep (belantamab mafodotin) was voluntarily withdrawn from the US market in November 2022 due to efficacy concerns. GSK has resubmitted the drug to the FDA with additional data, and the agency has set a Prescription Drug User Fee Act (PDUFA) date of October 23, 2025, for review.

What this means for patients:

  • No commercial availability until FDA re-approval
  • Insurance coverage limited to clinical trials or expanded access programs
  • Alternative BCMA-targeted therapies may be covered options

For Texas patients with relapsed/refractory multiple myeloma, Counterforce Health can help navigate coverage options for alternative therapies and assist with appeals if Blenrep becomes available again.

Cigna Prior Authorization Requirements

When Blenrep was commercially available, Cigna required prior authorization with specific clinical criteria. These requirements may apply if the drug returns to market:

Coverage at a Glance

Requirement Details Source
Diagnosis Relapsed or refractory multiple myeloma Cigna PA Form
Prior Therapies At least 4 prior regimens required Cigna PA Form
Required Classes Anti-CD38, proteasome inhibitor, immunomodulatory agent Cigna PA Form
REMS Program Enrollment required due to ocular toxicity FDA Requirements
Review Timeline 5 business days (standard) Cigna PA Form

Required Prior Therapies

Your treatment history must include:

  • Anti-CD38 antibody: Darzalex (daratumumab), Darzalex Faspro, or Sarclisa (isatuximab)
  • Proteasome inhibitor: Velcade (bortezomib), Kyprolis (carfilzomib), or Ninlaro (ixazomib)
  • Immunomodulatory agent: Revlimid (lenalidomide), Pomalyst (pomalidomide), or Thalomid (thalidomide)

Forms and Submission Process

Step-by-Step: Fastest Path to Approval

  1. Download Current Form
  2. Complete Clinical Documentation (Your oncologist handles this)
    • List all 4+ prior therapy regimens with dates and outcomes
    • Include current disease staging and performance status
    • Document contraindications to alternative therapies
  3. Submit Request
  4. Track Status
Tip: For urgent requests, your oncologist should call Cigna first to establish medical urgency before submitting the written form.

Appeals Process for Texas Patients

If Cigna denies coverage for Blenrep (when available), Texas patients have strong appeal rights under state law.

Internal Appeals with Cigna

Timeline: Submit within 180 days of denial notice

How to Appeal:

  1. Call the number on your Cigna ID card
  2. Submit written appeal using Cigna's appeal form
  3. Include supporting documentation from your oncologist

What to Include:

  • Medical necessity letter explaining why Blenrep is required
  • Documentation of prior therapy failures
  • Current disease status and treatment goals
  • Relevant clinical guidelines or studies

Texas Independent Review Organization (IRO)

If Cigna upholds the denial, Texas law provides access to an independent external review at no cost to you.

Requirements:

  • Complete Cigna's internal appeal process first
  • Submit Form LHL009 within 4 months of final internal denial
  • Send to Cigna (they forward to Texas Department of Insurance)

Timeline:

  • Standard review: 20 days
  • Expedited review: 5 days (for life-threatening conditions)
  • IRO decision is binding on Cigna

Contact for Help: Texas Department of Insurance Consumer Help Line at (800) 252-3439

Note: This process applies to Texas-regulated plans. ERISA self-funded employer plans follow federal appeal rules instead.

Alternative Coverage Options

Since Blenrep isn't currently available, focus on covered alternatives that target the same BCMA pathway:

BCMA-Targeted Therapies Typically Covered by Cigna

CAR-T Cell Therapies:

  • Abecma (ide-cel) - First-line BCMA CAR-T
  • Carvykti (cilta-cel) - Often covered for eligible patients

Bispecific Antibodies:

  • Tecvayli (teclistamab) - BCMA/CD3 bispecific
  • Elrexfio (elranatamab) - BCMA/CD3 bispecific

Standard Triplet Regimens:

  • Various combinations per NCCN guidelines
  • Often preferred by payers due to established safety profiles

Counterforce Health specializes in helping patients navigate coverage for these complex therapies, turning insurance denials into successful appeals with targeted, evidence-backed submissions.

Clinical Trial and Expanded Access

Finding Clinical Trials

Search Resources:

  • ClinicalTrials.gov - Search "belantamab mafodotin" and "multiple myeloma"
  • Major cancer centers in Texas (MD Anderson, Baylor, etc.)
  • GSK's clinical trial locator

What Trials May Cover:

  • Study drug at no cost
  • Some associated medical care
  • Travel assistance (varies by sponsor)

Expanded Access Programs

If you don't qualify for trials, ask your oncologist about:

  • GSK's compassionate use program (if available)
  • Right to Try laws (federal and Texas)
  • Individual patient INDs through FDA

Common Questions

Q: How long does Cigna prior authorization take in Texas? A: Standard review is 5 business days. Urgent cases (life-threatening conditions) can be expedited with a phone call to (800) 882-4462.

Q: What if Blenrep is non-formulary on my plan? A: Submit a formulary exception request with clinical justification for why covered alternatives aren't appropriate.

Q: Can I request an expedited appeal? A: Yes, if your condition is life-threatening or a delay would seriously jeopardize your health. Both Cigna and the Texas IRO offer expedited reviews.

Q: Does step therapy apply if I've failed treatments outside Texas? A: Your treatment history follows you. Document all prior therapies regardless of where they were tried.

Q: What happens if the IRO overturns Cigna's denial? A: The decision is binding. Cigna must cover the treatment as directed by the independent reviewers.

Q: Are there patient assistance programs for Blenrep? A: When commercially available, GSK typically offers patient support programs. Check with the manufacturer or organizations like the Multiple Myeloma Research Foundation.

Getting Help in Texas

State Resources

Texas Department of Insurance

Office of Public Insurance Counsel (OPIC)

Advocacy Organizations

Multiple Myeloma Research Foundation

  • Patient navigation services
  • Treatment information and support

Disability Rights Texas

  • Assistance with appeals and fair hearings
  • Representation for complex cases

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Insurance coverage decisions depend on your specific plan terms and clinical circumstances. Always consult with your healthcare provider and insurance company for personalized guidance. For professional assistance with complex appeals, consider consulting with healthcare advocates like Counterforce Health who specialize in turning insurance denials into successful approvals.

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