Medicare AdvantageCoverageMedium impact
MA08.139d, Loncastuximab tesirine-lpyl (Zynlonta®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Nov 17, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated the medical necessity criteria and general guidelines for Loncastuximab tesirine-lpyl (Zynlonta®), a specialty oncology medication. This policy change affects coverage requirements and documentation standards for this targeted cancer therapy.
Action Required
By November 17, 2025: Oncology billing teams must review and update prior authorization processes for Loncastuximab tesirine-lpyl (Zynlonta®) claims to align with new medical necessity criteria. Update documentation requirements in EMR templates and ensure providers are aware of revised guidelines to prevent claim denials.