By Counterforce Health Team in Blenrep (belantamab mafodotin) —

How to Renew Blenrep (belantamab mafodotin) Coverage with Cigna in California: Complete Timeline and Documentation Guide

Answer Box: Renewing Blenrep (belantamab mafodotin) with Cigna in California

Important Note: As of July 2025, Blenrep was re-approved by the FDA for relapsed/refractory multiple myeloma in combination with bortezomib and dexamethasone (BVd). However, access requires enrollment in the REMS program due to ocular toxicity risks. For patients currently on Blenrep through clinical trials or expanded access, renewal processes will transition to standard commercial coverage.

Fastest Path: Start renewal 4-6 weeks before your current authorization expires. Submit through Cigna's ePA portal with updated labs, imaging, and specialist notes showing continued benefit. If denied, California's Independent Medical Review (IMR) system has a 60-70% overturn rate for specialty drug denials.

First Step Today: Contact your oncologist to schedule updated labs (M-protein, free light chains) and confirm your current PA expiration date through Cigna's provider portal.

Table of Contents

  1. When to Start Your Renewal Process
  2. Required Documentation for Renewal
  3. Step-by-Step Renewal Process
  4. If Your Coverage Lapses
  5. Annual Formulary Changes
  6. California Appeal Rights
  7. Personal Tracking Template
  8. FAQ

When to Start Your Renewal Process

Timing is Critical

Most Cigna specialty drug prior authorizations are approved for 12-month periods, though some may be shorter for initial approvals. Begin your renewal process 4-6 weeks before expiration to avoid treatment interruptions.

Check Your Current Status:

  • Log into Cigna's member portal or have your clinic check the provider portal
  • Look for your PA expiration date
  • Note any quantity limits or step therapy requirements

Early Renewal Triggers

Start the renewal process immediately if you experience:

  • Disease progression requiring regimen changes
  • Significant side effects necessitating dose modifications
  • Insurance plan changes during annual enrollment
  • Pharmacy benefit changes from Cigna to Express Scripts or vice versa
Tip: Set a calendar reminder 6 weeks before your PA expires. Many patients miss this window and face treatment delays.

Required Documentation for Renewal

Core Medical Evidence

Your oncologist will need to provide:

Disease Status Documentation:

  • Recent M-protein levels (serum and urine electrophoresis)
  • Free light chain assay results and ratio
  • Bone marrow biopsy results (if repeated)
  • Imaging studies (PET-CT, MRI, or CT showing disease status)
  • IMWG response criteria assessment (complete response, very good partial response, partial response, stable disease, or progressive disease)

Treatment History:

  • Current line of therapy and cycle number
  • Previous treatments tried and reasons for discontinuation
  • Response to current Blenrep-containing regimen
  • Adherence and tolerance documentation

Clinical Justification:

  • Continued medical necessity based on NCCN Guidelines
  • Evidence of ongoing clinical benefit
  • Plan for continued monitoring, especially ophthalmologic exams required by the REMS program

REMS Compliance Documentation

Since Blenrep requires REMS enrollment, your renewal must include:

  • Current eye exam results from an enrolled ophthalmologist
  • Confirmation of continued REMS program participation
  • Documentation of patient education and monitoring compliance

Step-by-Step Renewal Process

Step 1: Gather Updated Lab Results (Week 6 Before Expiration)

  • Schedule appointments for M-protein, free light chains, and other disease markers
  • Arrange ophthalmology follow-up per REMS requirements
  • Request copies of recent imaging studies

Step 2: Clinical Documentation (Week 5 Before Expiration)

Your oncologist should prepare a medical necessity letter including:

  • Current disease status per IMWG criteria
  • Evidence of continued benefit from Blenrep combination therapy
  • Justification for continued use based on NCCN guidelines
  • REMS compliance confirmation

Step 3: Submit Renewal Request (Week 4 Before Expiration)

Primary Submission Method: Electronic Prior Authorization (ePA) through CoverMyMeds or your EHR system

Alternative Methods:

Step 4: Follow Up (Week 2-3 Before Expiration)

  • Confirm Cigna received your renewal request
  • Respond promptly to any requests for additional information
  • Prepare for potential peer-to-peer review if needed

Step 5: Decision and Next Steps

If Approved: Verify the new authorization period and any changes to quantity limits or restrictions

If Denied: Proceed immediately to the appeals process (see California Appeal Rights section below)

If Your Coverage Lapses

Bridge Coverage Options

If your PA expires before renewal is approved, you may be eligible for transition fills under Medicare Part D or commercial plan rules:

Transition Coverage Provides:

  • Up to 30-day supply at retail pharmacy
  • Continued access while appeals are pending
  • Time to complete prior authorization requirements

How to Access:

  1. Ask your pharmacy to process as a "transition fill"
  2. Call Cigna member services to confirm eligibility
  3. Use this time to complete your renewal or appeal process

Emergency Access

For urgent situations where treatment delays could cause serious harm:

  • Request expedited prior authorization (72-hour decision)
  • Contact GSK's Together with GSK program for patient assistance
  • Consider temporary access through manufacturer programs

Annual Formulary Changes

What Changes Each Year

Cigna typically updates its formulary during the Annual Enrollment Period (October 15 - December 7) with changes effective January 1:

  • Tier placement may change (affecting copays)
  • Prior authorization requirements may be added or modified
  • Quantity limits may be adjusted
  • Step therapy requirements may change

Preparing for Changes

Review Annual Documents:

Action Steps:

  • Compare your current coverage to next year's benefits
  • Consider switching plans during AEP if coverage worsens significantly
  • Prepare documentation for formulary exceptions if needed

California Appeal Rights

Internal Appeals with Cigna

Timeline: 180 days from denial date to file internal appeal Decision Time: 30 days for standard appeals, 72 hours for expedited

Required Documentation:

  • Copy of denial letter
  • Updated medical necessity letter
  • Supporting clinical evidence and guidelines

Independent Medical Review (IMR)

California's Department of Managed Health Care (DMHC) provides free, binding external review:

Eligibility: Available after internal appeal or if Cigna doesn't respond within 30 days Success Rate: 60-70% overturn rate for specialty drug denials Timeline: 45 days for standard IMR, 7 days for expedited Cost: Free to patients

How to File:

  • Complete DMHC IMR application
  • Include all medical records and denial correspondence
  • Call DMHC Help Center: 888-466-2219
From our advocates: In our experience helping California patients, IMR requests with strong specialist letters and current NCCN guideline citations are frequently successful, especially when the denial was based on "not medically necessary" rather than coverage exclusions. The key is comprehensive documentation of treatment history and ongoing benefit.

Personal Tracking Template

Renewal Checklist

6 Weeks Before Expiration:

  • Check PA expiration date
  • Schedule lab work and eye exam
  • Request recent imaging reports

4 Weeks Before Expiration:

  • Submit renewal request via ePA
  • Confirm all required documents included
  • Note submission confirmation number

2 Weeks Before Expiration:

  • Follow up on renewal status
  • Prepare for potential peer-to-peer review
  • Ready appeal documentation if needed

After Decision:

  • Update calendar with new expiration date
  • Review any changes to coverage terms
  • Plan next renewal cycle

FAQ

How long does Cigna take to decide on Blenrep renewals? Standard prior authorizations are decided within 5-7 business days. Complex cases requiring medical director review may take up to 14 days.

What if Blenrep moves to a higher formulary tier? You can request a tiering exception with documentation that formulary alternatives are inappropriate for your condition. California residents can appeal tier changes through IMR.

Can I get expedited review for my renewal? Yes, if treatment delay could seriously harm your health. Mark requests as "urgent" and have your oncologist document the medical urgency.

What counts as "continued benefit" for renewal? Stable disease or better per IMWG criteria, absence of unacceptable toxicity, and adherence to the treatment regimen and REMS requirements.

Does step therapy apply to Blenrep renewals? Generally no for renewals, but new PA requirements may be added. Document your treatment history thoroughly to support continued use.

What if my oncologist leaves or I change providers? The new provider can submit renewal requests, but they'll need complete medical records documenting your treatment history and current status.

About Counterforce Health

Counterforce Health specializes in helping patients, clinicians, and specialty pharmacies navigate complex prior authorization and appeal processes for prescription drugs. Our platform analyzes denial patterns and creates targeted, evidence-backed appeals that align with payer-specific requirements, significantly improving approval rates for specialty medications like Blenrep.

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Coverage decisions depend on individual circumstances and plan specifics. Always consult with your healthcare provider and insurance plan directly for personalized guidance. For assistance with appeals and prior authorizations, contact the California Department of Managed Health Care at 888-466-2219.

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