CommercialCoverageHigh impact
08.01.43q, Chimeric Antigen Receptor (CART) Therapy: Yescarta Tecartus, Breyanzi, Kymriah and Aucatzyl
Independence Blue Cross·PA · Oncology, Hematology, Pharmacy·Medical Policy
Effective date
Feb 9, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated Medical Policy 08.01.43q to expand CAR-T therapy coverage by adding new indications for existing drugs (Yescarta, Breyanzi, Kymriah), introducing a newly FDA-approved drug (Aucatzyl), and separating Abecma and Carvykti into a standalone policy. The policy now covers additional lymphoma subtypes and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) for multiple CAR-T products, with new HCPCS code Q2058 added for Aucatzyl administration.
Action Required
By February 9, 2026: (1) Billing team must add new HCPCS code Q2058 (Aucatzyl) to the billing system and claims processing software with proper coverage logic for medically necessary indications. (2) Update prior authorization workflows to include new approved indications: CLL/SLL for Yescarta and Kymriah; plasmablastic lymphoma subtype for Yescarta, Breyanzi, and Kymriah; transformed disease criteria for Yescarta; Richter transformation criteria for Breyanzi. (3) Providers and coding staff must verify that claims for these newly approved indications are properly coded with ICD-10 codes reflecting the specific lymphoma subtype or CLL/SLL diagnosis to support medical necessity. (4) Remove any references to Abecma and Carvykti from this policy version and direct all related claims to the new separate policy titled 'Chimeric Antigen Receptor (CART) Therapy: Carvykti® & Abecma®' to prevent claim processing errors. (5) Update internal policy documentation and reference materials to reflect the policy title change from 'CAR Therapy' to 'CART Therapy.' Failure to implement these changes will result in claim denials for Aucatzyl administration and new indications not yet reflected in system logic.