This letter confirms that the prior-authorization request submitted on behalf of Margaret Reilly (member ID AET-554782119) for Pembrolizumab 200mg IV q3w — Cycle 7 (continuation) has been approved.
The determination was rendered under Pembrolizumab (KEYTRUDA) Continuation Therapy (Aetna Clinical Policy Bulletin 0890, effective 2026-01-01). All 5 medical-necessity criteria were evaluated against the submitted clinical evidence.
Clinical rationale: NCCN-pathway aligned, biomarker confirmed, performance status stable, no toxicity barriers.
| Code | Display |
|---|---|
| C34.91 | Malignant neoplasm of upper lobe, right lung |
| Z51.81 | Encounter for therapeutic drug level monitoring |