CommercialCoverageMedium impact
08.02.36, Zolbetuximab-clzb (Vyloy®)
Independence Blue Cross·Pharmacy, Infectious Disease, Gastroenterology·Pharmacy
Effective date
Apr 21, 2025
We identified it
Jun 19, 2026
Summary
A new pharmacy policy for Zolbetuximab-clzb (Vyloy®) has been established effective April 21, 2025. This is a newly covered medication and the billing team must identify the specific HCPCS code, coverage criteria, and any prior authorization requirements by reviewing the full policy text to ensure accurate claims submission and reimbursement.
Action Required
By April 21, 2025: Billing team must obtain and review the complete policy text for 08.02.36 Zolbetuximab-clzb (Vyloy®) from the provided URL. Identify the HCPCS code for this medication, document coverage criteria, and determine if prior authorization is required. Update billing software and pharmacy claims submission processes accordingly. Communicate coverage details to providers and pharmacy staff. Claims submitted without compliance to this new policy may be denied.