CommercialCoverageHigh impact
08.01.33l, Leuprolide (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)
Independence Blue Cross·PA · Oncology, Urology, ENT (Ear, Nose & Throat) +3 more·Pharmacy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated Leuprolide policy 08.01.33l to version 08.01.33n, adding coverage for uterine neoplasms, revising prostate cancer and head/neck cancer criteria per NCCN guidelines, and introducing Camcevi ETM 21 mg (3-month formulation). Specific ICD-10 codes for inflammatory breast cancer and uterine malignancies were added or modified with different coverage rules by formulation. The preferred product designation remains leuprolide acetate (Eligard/Lupron Depot J9217) for prostate cancer and salivary gland tumors, with nonpreferred products (Camcevi, Camcevi ETM, Lupron Depot J1950) covered only for current/prior users or those with contraindications/intolerances.
Action Required
By December 29, 2025: (1) Billing team must update billing system to reflect new ICD-10 code coverage rules: C50.A1, C50.A2, C54.0, C54.3, C54.8, C54.9, and C55 are now covered for J1950 (Lupron Depot 3.75mg) and J9217 (Leuprolide acetate 7.5mg) only, NOT for J1951 (Fensolvi) or J1952 (Camcevi). (2) Remove C50.A0 from all leuprolide coverage rules in billing system. (3) Add HCPCS code J9003 (Camcevi ETM 1mg) to system as nonpreferred product with same restrictions as J1952 (Camcevi). (4) Update prior authorization logic to require documentation of prior/current leuprolide use or contraindication/intolerance when nonpreferred products (J1952, J9003, J1950) are billed for prostate cancer or salivary gland tumors; preferred product J9217 requires no such documentation. (5) Update billing staff training on new uterine neoplasm indications now covered under this policy. (6) Modify claim submission templates to prompt providers to indicate formulation and verify ICD-10 code/HCPCS code pairing matches coverage rules. Failure to apply correct coverage rules will result in claim denials or payment delays.