All PlansCoverageMedium impact
08.02.13a, Delandistrogene moxeparvovec (delandistrogene moxeparvovec-rokl; Elevidys®)
Independence Blue Cross·Pharmacy, Oncology·Pharmacy
Effective date
May 28, 2025
We identified it
Jun 19, 2026
Summary
This is a reissue of the policy for delandistrogene moxeparvovec (Elevidys®), a gene therapy treatment. The policy establishes coverage and billing guidelines for this pharmaceutical. As a reissue effective 05/28/2025, the billing team must review the complete updated policy requirements to ensure claims are processed correctly under the new policy terms.
Action Required
By 05/28/2025: Billing team must obtain and review the complete full policy text for 08.02.13a from the provided URL to identify specific billing codes, prior authorization requirements, medical necessity criteria, and coverage limitations for delandistrogene moxeparvovec (Elevidys®). Update billing system rules, prior authorization workflows, and claim submission procedures accordingly. Provider education may be required. The summary provided does not include specific codes or requirements—access the full policy document to determine complete implementation steps and ensure claims are not denied due to non-compliance with updated coverage criteria.