Medicare AdvantageCoverageMedium impact
MA08.165c, Epcoritamab-bysp (EPKINLY®)
Independence Blue Cross·Pharmacy, Oncology·Pharmacy
Effective date
Apr 20, 2026
We identified it
Jun 19, 2026
Summary
Policy MA08.165c establishes medical necessity criteria and guidelines for Epcoritamab-bysp (EPKINLY®), a new pharmaceutical agent. This recent policy update (effective 04/20/2026) requires the billing and clinical teams to understand coverage requirements, likely including prior authorization and documentation standards for this drug when used in covered indications.
Action Required
By 04/20/2026: Billing team and providers must review the full policy text at the provided URL to identify specific prior authorization requirements, covered diagnoses, and documentation standards for EPKINLY® claims. Update billing system rules to enforce any new prior auth workflows. Pharmacy staff should coordinate with clinical teams to ensure prescriptions meet medical necessity criteria before submission. Obtain the complete policy details from the source URL to identify specific HCPCS/J-codes and ICD-10 requirements, as they are not detailed in this notification. Claims submitted without adherence to medical necessity criteria will be denied.