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BCMA Managed Care in MM
BCMA Has Moved Upstream—Managed Care Strategy Must Follow

Released: May 22, 2026

James A. Davis
James A. Davis, PharmD, BCOP
Donald Moore
Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP, FASHP
Anthony Perissinotti
Anthony Perissinotti, PharmD, BCOP
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Key Takeaways
  • Agents targeting BCMA in multiple myeloma have moved earlier in the treatment disease course, and managed care strategy must move with it.
  • Prior authorization should confirm appropriate patient selection and safety infrastructure, but it should not delay access until patients are too frail, too refractory, or too logistically constrained to benefit.
  • Early relapsed myeloma is now the place where evidence, operational readiness, and patient-centered value must meet.

The Decera Clinical Education program, Targeting BCMA in Early Relapsed/Refractory Myeloma: Translating New Clinical Evidence Into Managed Care Strategies, captured a defining transition in multiple myeloma (MM) care: BCMA-directed therapy is no longer limited to being a late-line rescue strategy, but an increasingly relevant option at early relapse. The live symposium was designed for oncology and managed care pharmacists and other professionals caring for patients with MM, with topics spanning BCMA biology, formulary implications, recent clinical updates, ocular toxicity management, and managed care implementation.

Read on for expert insights on implementing BCMA-directed therapies into your practice.

Why is BCMA-directed therapy crucial in the treatment paradigm for patients with MM?

James A. Davis, PharmD, BCOP
MM remains a disease characterized by cycles of remission and relapse, with each successive remission often becoming more difficult to attain and shorter in duration. Therefore, early relapse is a critical opportunity to utilize the most effective therapy to change the disease trajectory rather than simply recycle less effective conventional triplet therapies.

The biologic rationale for BCMA targeting remains straightforward and clinically compelling. BCMA is expressed on plasma cells and MM cells, making it a highly actionable target for antibody–drug conjugates (ADCs), bispecific antibodies, and CAR T-cell therapies. Soluble BCMA is a marker associated with disease burden. This target has now generated multiple therapeutic “buckets”: One-time autologous CAR T-cell therapy, off-the-shelf bispecific antibody therapy, and BCMA-directed ADC therapy. The managed care implication is crucial; these agents share a target, but they are not interchangeable drugs.

What are the most exciting treatment advances for targeting BCMA that are currently on your radar?

Anthony Perissinotti, PharmD, BCOP
The timeliest advance for treating patients with MM has been teclistamab plus daratumumab. On March 5, 2026, the FDA approved teclistamab with daratumumab hyaluronidase for adults with relapsed/refractory (R/R) myeloma after at least 1 prior line of therapy, including a proteasome inhibitor (PI) and an immunomodulatory drug (IMiD). In the phase III MajesTEC-3 trial, the median progression-free survival was significantly longer with teclistamab/daratumumab vs investigator’s choice DPd or DVd. Overall survival (OS) also significantly improved with the combination. This is exactly the kind of evidence that should prompt health plans and pharmacy and therapeutics committees to revisit pathways that still reserve BCMA-directed therapy for very late relapse.

BCMA-directed CAR T-cell therapy has also moved earlier in the R/R MM treatment sequence, with cilta-cel now indicated for adults with R/R MM after at least 1 prior line, including a PI and an IMiD, whose disease is refractory to lenalidomide. Idecabtagene vicleucel is indicated after 2 or more prior lines, including an IMiD, PI, and anti-CD38 monoclonal antibody. For managed care, this means that early referral, authorization timing, bridging therapy, caregiver assessment, travel support, and treatment center access are now part of quality care and not merely administrative details.

Belantamab mafodotin provides a different but important BCMA-targeted therapy option. The FDA approved belantamab mafodotin-blmf with bortezomib and dexamethasone on October 23, 2025, for adults with R/R myeloma after at least 2 prior lines, including a PI and an IMiD. In the phase III DREAMM-7 trial, median progression-free survival was extended with belantamab/bortezomib/dexamethasone vs daratumumab/bortezomib/dexamethasone, and OS also favored the belantamab regimen.

What type of treatment toxicities are associated with BCMA-directed therapy, and how do you manage them?

Anthony Perissinotti, PharmD, BCOP
Although belantamab mafodotin has shown immense clinical value for patients, ocular safety remains a concern. Ocular toxicity is a common adverse event with belantamab mafodotin treatment; as a result, belantamab mafodotin-blmf is available only through the BLENREP Risk Evaluation and Mitigation Strategy (REMS). As part of this program, patients require ophthalmic monitoring and dose modifications as indicated.

Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP, FASHP
Differences in administration, operations, and toxicity management are important considerations when choosing between different anti-BCMA–directed therapies. CAR T-cell therapies, bispecific antibodies, and ADCs are all operationally quite different. CAR T-cell therapy is front loaded, logistically intense, and potentially treatment free after infusion. Bispecific antibodies are off-the-shelf and scalable, but require step-up dosing, CRS/ICANS preparedness, infection prevention, and REMS workflows. Belantamab mafodotin is also off-the-shelf and may be useful for patients who cannot access or tolerate CAR T-cell therapy logistics, but it may require ophthalmology or optometry coordination, artificial tears, avoidance of contact lenses, dose holds, and dose reductions.

Infection prevention should also be prioritized when designing treatment plans. Consensus recommendations for patients receiving bispecific antibodies include universal herpes simplex and varicella zoster virus prophylaxis, hepatitis B screening, monthly intravenous immunoglobulin for immunoparesis, colony-stimulating factors for high-grade neutropenia, and universal Pneumocystis jirovecii pneumonia prophylaxis. More recent multi-institutional data suggest that primary intravenous immunoglobulin prophylaxis in recipients of BCMA-directed bispecific antibodies may improve infection-free outcomes and is associated with improved OS, supporting emphasis on proactive supportive care.

Treatment sequencing remains unsettled, but personalized treatment strategies are continuing to emerge. For fit, lenalidomide-refractory patients at first relapse, early CAR T-cell therapy referral should be normalized. For patients needing rapid off-the-shelf therapy or lacking access to CAR T-cell therapy, bispecific therapy may be appropriate. For patients with frailty, travel barriers, or difficulty navigating prolonged step-up dosing, belantamab -based therapy may offer a practical alternative after appropriate prior therapy. Prior BCMA exposure, duration of response, disease tempo, extramedullary disease, caregiver availability, infection risk, ocular comorbidity, and patient preference should all shape sequencing decisions.

Your Thoughts
How are you currently working BCMA-targeted agents into your armamentarium for R/R MM?

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Have you incorporated the recently approved indications for belantamab mafodotin and teclistamab plus daratumumab into your care plans for your practice?

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