Medicare AdvantageCoverageMedium impact
MA08.083l, Leuprolide (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)
Independence Blue Cross·Oncology, Urology, ENT (Ear, Nose & Throat) +2 more·Pharmacy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA08.083l to MA08.083n effective 12/29/2025, adding coverage for uterine neoplasms, revising prostate cancer and head/neck cancer criteria per NCCN guidelines, adding the new Camcevi ETM 21 mg 3-month formulation, and modifying ICD-10 code coverage to specify laterality for breast inflammatory neoplasms. The preferred product designation remains leuprolide acetate (Eligard and Lupron Depot 7.5 mg, J9217) for prostate cancer and salivary gland tumors.
Action Required
By 12/29/2025: (1) Billing team must update claim submission logic to recognize new ICD-10 codes C50.A1, C50.A2 (replacing C50.A0 for leuprolide acetate J1950 and J9217 only) and C54.0, C54.3, C54.8, C54.9, C55 (for uterine neoplasms coverage). (2) Add Camcevi ETM HCPCS code J9003 and the new Camcevi ETM 21 mg 3-month formulation to the billing system's drug database and prior authorization logic. (3) Verify that preferred product rules remain: J9217 (Eligard/Lupron Depot 7.5 mg) is preferred for prostate cancer and salivary gland tumors; nonpreferred products (J1950, J1952, J9003) require prior auth or history of prior use for these indications. (4) Update authorization templates to reflect new NCCN guideline-based coverage for head/neck cancers and prostate cancer. (5) Flag claims with removed code C50.A0 and redirect to appropriate laterality codes. Failure to implement these changes will result in claim denials for uterine neoplasm indications and processing errors for new formulations.