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Independence Blue CrossMedicare Advantage · Coverage · Pharmacy · Oncology, HematologyMedium impact

MA08.139d, Loncastuximab tesirine-lpyl (Zynlonta®)

Act
by Nov 17, 2025
Effective date
Nov 17, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated MA08.139d to clarify coverage criteria for loncastuximab tesirine (Zynlonta) for relapsed/refractory large B-cell lymphoma and histologic transformation to DLBCL, aligned with FDA and NCCN guidelines. The policy specifies that coverage applies as third-line or subsequent therapy under Part B medical benefits, excludes patients with bulky disease (≥10 cm) or active CNS lymphoma, and clarifies this does not address Part D pharmacy benefit coverage.

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What to do

by Nov 17, 2025 · 6 steps
01Billing team must update prior authorization protocols and billing system rules to enforce the new coverage criteria for HCPCS code J9359 (loncastuximab tesirine-lpyl).
02Require documentation that patient has received two or more prior lines of systemic therapy before approving claims.
03Implement automated edits to deny or hold claims for patients with bulky disease (≥10 cm) or active CNS lymphoma.
04Ensure claims are only processed under Part B medical benefit (not Part D).
05Update claim submission templates to require diagnosis codes confirming DLBCL NOS, high-grade B-cell lymphoma, histologic transformation to DLBCL, or other specified subtypes.
06Train billing and authorization staff on exclusion criteria.
If missed: Failure to implement these controls will result in claim denials and rework.

Codes mentioned

J9359

Original notice

MA08.139d, Loncastuximab tesirine-lpyl (Zynlonta®)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA08.139e, Loncastuximab tesirine-lpyl (Zynlonta®)MediumEffective Nov 2, 2026 · Pharmacy08.00.59e, Loncastuximab tesirine-lpyl (Zynlonta®)MediumEffective Nov 2, 2026 · Pharmacy08.00.59d, Loncastuximab tesirine-lpyl (Zynlonta®)MediumEffective Nov 17, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesOncologyHematologyCode J9359

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