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Independence Blue CrossCommercial · Coverage · Pharmacy · Oncology, Hematology, PharmacyMedium impact

08.00.59d, Loncastuximab tesirine-lpyl (Zynlonta®)

Act
by Nov 17, 2025
Effective date
Nov 17, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated Medical Policy 08.00.59d to clarify coverage criteria for Loncastuximab tesirine-lpyl (Zynlonta®) in alignment with FDA and NCCN guidelines. The policy covers the drug as third-line and subsequent therapy for relapsed/refractory large B-cell lymphoma and histologic transformation to DLBCL under specific clinical conditions, while excluding patients with bulky disease (≥10 cm) or active CNS lymphoma.

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What to do

by Nov 17, 2025 · 5 steps
01Billing team must update claims processing systems and prior authorization workflows to enforce coverage criteria for HCPCS code J9359 (loncastuximab tesirine-lpyl).
02Implement requirement to verify: (1) patient has received 2+ prior lines of systemic therapy, (2) disease status (partial response, no response, or progressive disease), (3) absence of bulky disease (≥10 cm) or active CNS lymphoma, and (4) appropriate diagnosis code (relapsed/refractory DLBCL or histologic transformation to DLBCL).
03Providers must document prior therapy history and disease response status in claim submissions.
04Update claim denial rules to reject claims lacking required documentation or meeting exclusion criteria.
05Train billing staff on new DLBCL subtype requirements (DLBCL NOS, high-grade B-cell lymphoma with double/triple hit, AIDS/HIV-related DLBCL, post-transplant lymphoproliferative disorders, transformed follicular lymphoma).
If missed: Failure to verify criteria will result in claim denials.

Codes mentioned

J9359

Original notice

08.00.59d, Loncastuximab tesirine-lpyl (Zynlonta®)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA08.139e, Loncastuximab tesirine-lpyl (Zynlonta®)MediumEffective Nov 2, 2026 · Pharmacy08.00.59e, Loncastuximab tesirine-lpyl (Zynlonta®)MediumEffective Nov 2, 2026 · PharmacyMA08.139d, Loncastuximab tesirine-lpyl (Zynlonta®)MediumEffective Nov 17, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesOncologyHematologyPharmacyCode J9359

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