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08.01.67c, Lurbinectedin (Zepzelca®)
Effective date
Not stated in the notice
Identified
Jun 19, 2026
Summary
Independence Blue Cross reissued policy 08.01.67d for lurbinectedin (Zepzelca®) to communicate continuing coverage position for small cell lung cancer treatment. The policy maintains coverage for primary treatment maintenance therapy, subsequent systemic therapy, and progression/relapse scenarios with specific clinical criteria. No substantive coverage changes from prior version 08.01.67c; this is a routine reissue.
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What to do
Action · 4 steps
01No immediate action required.
02Billing team should verify their system reflects HCPCS code J9223 (lurbinectedin 0.1 mg) for lurbinectedin claims.
03Confirm prior authorization requirements align with policy criteria: ECOG performance status documentation (0-2 for single agent; 0-1 for combination therapy), confirmation that lurbinectedin has not been previously used for progression/relapse, and verification of disease status (stable disease or better after chemotherapy cycles).
04For Pennsylvania commercial members with Stage 4 metastatic cancer, refer to policy 08.01.08 for additional coverage requirements per the Fair Access to Cancer Treatment Act.
Codes mentioned
J9223
Original notice
08.01.67c, Lurbinectedin (Zepzelca®)
medpolicy.ibx.com · Always check the source before changing claims.