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Independence Blue CrossCommercial · Coverage · Pharmacy · Oncology, Hematology, PharmacyHigh impact

08.00.46f, Isatuximab-irfc (Sarclisa®, Sarclisa Escena)

Effective date
Oct 19, 2026
Identified
Oct 20, 2026

Summary

Independence Blue Cross updated policy 08.00.46f to add coverage for a new subcutaneous formulation of isatuximab-irfc (Sarclisa Escena), approved by FDA on July 9, 2026, for multiple myeloma treatment. The policy also expanded coverage criteria for the intravenous formulation (Sarclisa) to include additional primary therapy regimens and added coverage for plasma cell-related conditions (POEMS, MIDD, MGRS). New HCPCS and ICD-10 diagnosis codes have been added to support billing for both formulations.

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What to do

Action · 5 steps
01Effective 2026-10-19: Billing team must immediately update billing software and claims submission protocols to recognize two new HCPCS codes for Sarclisa Escena (C9399 and J3590) alongside the existing J9227 code for intravenous Sarclisa.
02Update system documentation and prior authorization workflows to reflect expanded coverage for primary therapy regimens in non-ASCT candidates and transplant-deferred patients under age 80 who are not frail, as well as new coverage for POEMS, MIDD, and MGRS when used with isatuximab-irfc.
03Ensure all nine ICD-10 codes (C90.00, C90.01, C90.02, C90.20, C90.21, C90.22, and D47.2) are available for selection on encounter forms and claims.
04Verify provider awareness of the distinction between subcutaneous (Sarclisa Escena) and intravenous (Sarclisa) administration routes, as they use different codes.
05No future deadline applies; the policy is already effective.

Codes mentioned

J9227C9399J3590C90.00C90.01C90.02C90.20C90.21C90.22D47.2

Original notice

08.00.46f, Isatuximab-irfc (Sarclisa®, Sarclisa Escena)
medpolicy.ibx.com · Always check the source before changing claims.
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Related policy hubs

Independence Blue Cross policiesOncologyHematologyPharmacyCode J9227Code C9399Code J3590Code C90.00Code C90.01Code C90.02Code C90.20Code C90.21Code C90.22Code D47.2

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