Epcoritamab-bysp (Epkinly™)

Before September 30, 2026: Billing and prior authorization teams must implement the Epkinly coverage criteria into the authorization system. Specifically: (1) Configure prior auth requirements for Epkinly use in B-cell lymphomas, requiring documentation of disease type, treatment line, and response status; (2) Set authorization limits to 12 months maximum per approval; (3) For follicular lymphoma combination therapy with lenalidomide and rituximab, enforce 12-cycle maximum across all prior authorizations; (4) Require providers to document at least 2 prior lines of systemic therapy for monotherapy approvals; (5) Update encounter templates and approval workflows to match the three coverage pathways listed in the policy; (6) Train billing, prior auth, and provider relations staff on the new requirements. Failure to implement these controls will result in claim denials for non-compliant requests and potential rework.