Medicare AdvantageCoverageMedium impact
MA08.044l, Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration
Independence Blue Cross·Hematology, Nephrology, Neurology +2 more·Pharmacy
Effective date
Jul 8, 2026
We identified it
Jul 9, 2026
Summary
This is a reissued Medicare Advantage policy on Eculizumab (Soliris®), related biosimilars, and Ravulizumab-cwvz (Ultomiris™) for intravenous administration. The policy was reissued on 07/08/2026 with an effective date of 07/08/2026, indicating coverage criteria, prior authorization requirements, or billing guidance for these specialty biologic medications have been updated or clarified.
Action Required
By 07/08/2026: Billing team must obtain and review the full policy text for MA08.044l to identify specific prior authorization requirements, covered indications, and applicable HCPCS codes (likely J3357, J3358, or related eculizumab/ravulizumab administration codes). Update billing system rules and prior auth workflows accordingly. Communicate any prior auth changes to providers and update encounter templates. Verify coverage criteria for complement-mediated conditions. Claims submitted without adherence to updated requirements will be subject to denial.