CommercialPrior AuthMedium impact
08.00.46e, Isatuximab-irfc (Sarclisa®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Mar 24, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.00.46e for Isatuximab-irfc (Sarclisa®) has been updated with changes to medical necessity criteria, medical coding guidelines, and general informational content. This affects pharmacy-related billing for this cancer medication used primarily in multiple myeloma treatment.
Action Required
By March 24, 2025: Billing team must review updated medical necessity criteria and coding guidelines for Isatuximab-irfc (Sarclisa®) claims. Update prior authorization processes and documentation requirements in billing system. Notify oncology providers of new criteria to ensure proper documentation before drug administration.