CommercialPrior AuthHigh impact
Linvoseltamab-gcpt (Lynozyfic) (CPB 1089, reviewed 2026-07-17)
Aetna·Oncology, Hematology·Medical Policy
Effective date
Jul 17, 2026
We identified it
Aug 16, 2026
Summary
Aetna has established a new clinical policy (CPB 1089, effective 2026-07-17) covering linvoseltamab-gcpt (Lynozyfic), a bispecific T-cell engager for relapsed or refractory multiple myeloma patients who have received at least 4 prior therapies including specific drug classes. This new drug requires mandatory precertification before administration and follows a strict step-up dosing schedule with hospitalization requirements for the first two doses.
Action Required
By 2026-07-17: Billing team must implement mandatory precertification workflow for linvoseltamab-gcpt (Lynozyfic) claims. (1) Configure billing system to flag all claims with HCPCS code J9601 and CPT codes 96413-96415 paired with ICD-10 codes C90.00 or C90.02 as requiring prior authorization; (2) Update precertification protocols to require documentation that patient has received at least 4 prior therapies including proteasome inhibitor, immunomodulatory agent, and anti-CD38 monoclonal antibody; (3) Brief clinical staff and providers that precertification calls go to (866) 752-7021 or fax (888) 267-3277, with Statement of Medical Necessity forms available through Specialty Pharmacy Precertification; (4) Document in encounter forms that linvoseltamab-gcpt requires 24-hour hospitalization following first and second step-up doses; (5) Flag chemotherapy administration codes (96413-96415) when billed with J9601 to ensure bundling accuracy. Claims submitted without precertification will be denied per Aetna commercial policy requirements.