Medicare AdvantagePrior AuthMedium impact
MA08.040b, Telisotuzumab vedotin-tllv (Emrelis™)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Jun 29, 2026
We identified it
Jun 30, 2026
Summary
MA08.040b updates medical necessity criteria for Telisotuzumab vedotin-tllv (Emrelis™), a specialty pharmaceutical agent. This is a Medicare Advantage pharmacy policy change effective immediately. The billing team must review the specific medical necessity requirements in the full policy to ensure prior authorization and claims submissions comply with the new criteria.
Action Required
By 06/29/2026: Billing team must obtain and review the complete MA08.040b policy text from the source URL to identify specific medical necessity criteria for Telisotuzumab vedotin-tllv (Emrelis™). Update prior authorization workflows and claim submission processes to enforce these criteria. Coordinate with providers and pharmacy staff to ensure all Emrelis™ prescriptions include required clinical documentation supporting medical necessity before claim submission. Flag any claims submitted without proper medical necessity documentation for denial prevention. Document policy requirements in billing system and communicate changes to all relevant staff.