Medicare AdvantageCoverageMedium impact
Tildrakizumab-asmn (Ilumya®)
Independence Blue Cross·PA · Dermatology, Rheumatology·Pharmacy
Effective date
Sep 14, 2026
We identified it
Jun 16, 2026
Summary
Medicare Advantage policy for Tildrakizumab-asmn (Ilumya®) adds new requirement prohibiting concurrent therapy with other biologic DMARDs or JAK inhibitors for continuation therapy. All ICD-10 codes removed from policy, requiring providers to report appropriate diagnosis codes supporting medical necessity.
Action Required
Before September 14, 2026: Dermatology and rheumatology providers must update documentation to confirm no concurrent biologic DMARD or JAK inhibitor therapy for Tildrakizumab-asmn continuation therapy claims. Remove ICD-10 code references from billing templates and ensure appropriate diagnosis codes supporting medical necessity are documented in patient records. Update prior authorization requests to include this new criterion.