CommercialPrior AuthMedium impact
08.01.21h, Blinatumomab (Blincyto®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Oct 20, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.01.21h for Blinatumomab (Blincyto®) has been updated effective October 20, 2025, with changes to medical necessity criteria, medical coding, and general guidelines. The billing team must review updated coverage requirements and coding guidance to ensure compliant claim submission for this specialty pharmaceutical agent.
Action Required
By October 20, 2025: Billing team must obtain and review the complete policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=10&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-01-21h to identify specific medical necessity criteria, updated coding requirements, and any prior authorization mandates for Blinatumomab claims. Update billing protocols, prior authorization templates, and provider education materials to reflect new requirements. Ensure all Blinatumomab claims submitted on or after October 20, 2025 comply with updated medical necessity documentation standards. Non-compliance will result in claim denials.