CommercialDocumentationMedium impact
08.00.59d, Loncastuximab tesirine-lpyl (Zynlonta®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Nov 17, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.00.59d updates medical necessity criteria and general guidelines for Loncastuximab tesirine-lpyl (Zynlonta®), a CD19-directed antibody-drug conjugate used in hematologic malignancies. The billing team must review updated coverage requirements and prior authorization rules effective immediately.
Action Required
By November 17, 2025: Billing and clinical teams must review the full policy text at the provided URL to identify specific medical necessity criteria, prior authorization requirements, and coverage limitations for Loncastuximab tesirine-lpyl (Zynlonta®). Update billing system rules, prior authorization workflows, and clinical documentation templates accordingly. Providers should verify patient eligibility and obtain required authorizations before administering this drug. Claims submitted without compliance to updated medical necessity criteria may be denied.