Medicare AdvantageCoverageMedium impact
MA08.013, Revakinagene taroretcel-lwey (Encelto®)
Independence Blue Cross·MA · Pharmacy, Oncology·Pharmacy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
MA08.013 is a new Medicare Advantage policy establishing coverage criteria and billing requirements for Revakinagene taroretcel-lwey (Encelto®), a newly approved cell therapy product. This policy defines medical necessity, prior authorization requirements, and covered indications for this pharmaceutical product effective immediately.
Action Required
By January 15, 2026: Billing team and providers must review MA08.013 policy details to understand prior authorization requirements and covered indications for Encelto®. Pharmacy staff should obtain the full policy text from the source URL to identify specific HCPCS/J-codes, medical necessity criteria, and documentation requirements. Update billing system and pharmacy management software to flag all Encelto® claims for mandatory prior authorization review before dispensing or billing. Failure to obtain prior authorization will result in claim denials. Communicate policy requirements to all prescribing providers and pharmacy personnel.