CommercialCoverageLow impact
08.02.18, Elranatamab-bcmm (Elrexfio™)
Independence Blue Cross·PA · Oncology, Hematology, Pharmacy·Pharmacy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued policy 08.02.18a for Elrexfio (elranatamab-bcmm) as part of its annual review process. Coverage criteria remain unchanged: the drug is covered for adult patients with relapsed/refractory multiple myeloma who have received at least four prior therapies including specific drug classes. Hospital admission for first-cycle administration (48 hours after first dose, 24 hours after second dose) is covered per FDA recommendations to monitor for cytokine release syndrome and neurotoxicity.
Action Required
No immediate action required. This is an annual policy reissuance with no substantive coverage changes. Billing team should verify that current claim submissions for HCPCS code J1323 already include: (1) documentation of at least four prior therapies (proteasome inhibitor, immunomodulatory agent, anti-CD38 monoclonal antibody, plus one additional line), (2) diagnosis code supporting refractory/relapsed multiple myeloma, and (3) hospital admission coding for first-cycle administration when applicable. Update internal policy reference files to version 08.02.18a to reflect current guidance. Note: Version 08.02.18 is superseded and should no longer be referenced.