Who is affected by this change?

This affects Independence Blue Cross Oncology, Hematology providers on Medicare Advantage plans.

When does this change take effect?

This change is effective Mar 24, 2025.

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Medicare AdvantageCoverageMedium impact

MA08.165b, Epcoritamab-bysp (EPKINLY®)

Independence Blue Cross·Oncology, Hematology·Pharmacy

Effective date

Mar 24, 2025

We identified it

Jun 19, 2026

Days to comply

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Summary

Medicare Advantage policy MA08.165b for Epcoritamab-bysp (EPKINLY®) has been updated with changes to medical necessity criteria, medical coding requirements, and general guidelines. This affects billing and coverage determinations for this oncology medication.

Action Required

Action needed

By March 24, 2025: Billing team and oncology providers must review updated medical necessity criteria for Epcoritamab-bysp (EPKINLY®). Update prior authorization documentation requirements and coding guidelines in billing system. Ensure compliance with new criteria to prevent claim denials for this specialty oncology medication.

Related policy hubs

Independence Blue Cross policies Oncology Hematology