Medicare AdvantageCoverageMedium impact
MA08.165c, Epcoritamab-bysp (EPKINLY®)
Independence Blue Cross·Oncology, Hematology, Pharmacy·Pharmacy
Effective date
Apr 20, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA08.165c to reflect FDA's expanded approval of Epcoritamab-bysp (Epkinly) in combination with lenalidomide and rituximab for relapsed/refractory follicular lymphoma, and added new coverage pathways for DLBCL second-line therapy with GemOx and Richter transformation treatment per NCCN guidelines. Billing teams must update prior authorization and coverage criteria to reflect these three new clinical indications effective April 20, 2026.
Action Required
By April 20, 2026: Billing and prior authorization teams must update system rules and clinical criteria in the authorization platform to reflect three new coverage pathways for HCPCS code J9321 (Injection, epcoritamab-bysp): (1) Follicular lymphoma in combination with lenalidomide and rituximab (R2), (2) DLBCL second-line with GemOx combination therapy per specified relapse/refractory criteria, and (3) Richter transformation as systemic therapy per NCCN 2.2026 guidelines. Update prior authorization templates to include these new indications. Providers must document which indication is being treated. Claims submitted without authorization under these new pathways will be denied if prior auth is required under the member's plan.