CommercialCoverageMedium impact
08.02.50, Chimeric Antigen Receptor Therapy (CART): Carvykti® & Abecma®
Independence Blue Cross·Hematology, Oncology, Pharmacy·Pharmacy
Effective date
Feb 9, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has published a new CAR-T therapy policy (08.02.50) effective 02/09/2026 that consolidates coverage for Carvykti and Abecma, replacing the previous policy 08.01.43q. The policy expands approved indications to include POEMS, MIDD, and plasma cell–related MGRS in addition to relapsed/refractory multiple myeloma, with specific medical necessity criteria and organ function requirements for both drugs.
Action Required
By 02/09/2026: Billing team must update billing system and documentation templates to reflect the new policy 08.02.50. (1) Archive references to the old policy 08.01.43q for Yescarta, Tecartus, Breyanzi, Kymriah, and Aucatzyl (now in separate policy). (2) Update prior authorization requirements for Carvykti (Q2056) to require one prior line of therapy meeting specific criteria (proteasome inhibitor + immunomodulatory agent, refractory to lenalidomide, OR three prior lines), no prior BCMA-targeted therapy, and no recent HSCT. (3) Update prior authorization requirements for Abecma (Q2055) to require two prior lines of therapy meeting specific criteria and no prior BCMA-targeted therapy. (4) Ensure all CAR-T claims include documentation of organ/bone marrow function per guidelines (ECOG status 0-1, LVEF ≥45%, eGFR ≥60, ALT ≤5x ULN, bilirubin ≤2.0 mg/dL, ANC >1,000, ALC ≥300, platelets ≥50,000, Hgb >8.0). (5) Update encounter templates and provider education to reflect new approved indications (POEMS, MIDD, MGRS in addition to R/R MM). Claims submitted without proper prior authorization documentation or missing required medical necessity criteria will be denied.