CommercialCoverageMedium impact
08.02.12c, Epcoritamab-bysp (EPKINLY®)
Independence Blue Cross·PA · Oncology, Hematology, Pharmacy·Pharmacy
Effective date
Apr 20, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross expanded coverage of epcoritamab-bysp (Epkinly) effective 04/20/2026 to include: (1) combination therapy with lenalidomide and rituximab (R2) for relapsed/refractory follicular lymphoma, (2) GemOx + Epkinly for DLBCL second-line treatment, and (3) single-agent therapy for Richter transformation. Billing teams must update authorization criteria and documentation requirements to reflect these three new covered indications.
Action Required
By 04/20/2026: Billing and prior authorization teams must update coverage rules in authorization systems and medical billing software to include three new covered indications: (1) Epkinly + lenalidomide + rituximab (R2) for relapsed/refractory follicular lymphoma, (2) Epkinly + GemOx for DLBCL second-line (relapsed <12 months, primary refractory, relapsed >12 months if no transplant intent, or alternative therapy), and (3) Epkinly single-agent for Richter transformation. Update prior authorization templates and provider guidelines to reference NCCN 2.2026 guidelines. Train authorization staff on new indications and ensure encounter documentation captures the specific indication being treated. Claims submitted without appropriate medical necessity documentation for these new indications will be subject to denial after the effective date.