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MA08.045q, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection
Act
by Jul 1, 2026
Effective date
Jul 1, 2026
Identified
Jul 23, 2026
Summary
Independence Blue Cross updated MA08.045q to MA08.045r (effective 07/01/2026), designating tocilizumab-anoh (Avtozma) as an additional preferred product alongside tocilizumab-aazg (Tyenne), and added three new HCPCS codes (M0231, M0232, Q0234) for tocilizumab-bavi COVID-19 treatment in hospitalized patients. Billing teams must update system configurations to recognize the new preferred product status and implement the new COVID-19 specific codes for claims processing.
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What to do
by Jul 1, 2026 · 6 steps
01Billing team must update billing software and claims processing system to recognize tocilizumab-anoh (Avtozma IV) as a preferred product for coverage purposes.
02Update pharmacy benefit configuration to reflect both tocilizumab-aazg (Tyenne) and tocilizumab-anoh (Avtozma) as preferred products with lower/no prior authorization requirements.
03Add new HCPCS codes M0231, M0232, and Q0234 to billing system for COVID-19 hospitalized patient infusions and injections of tocilizumab-bavi.
04Configure system to reject or flag claims using nonpreferred tocilizumab products (Actemra IV, Tofidence IV, other biosimilars) unless prior authorization documentation shows contraindication, intolerance, or inadequate response to preferred products.
05Update provider communications and prior authorization templates to reflect new preferred product designation.
06Test all changes before effective date to ensure claims process correctly.
Codes mentioned
J3262M0231M0232M0233Q0234
Original notice
MA08.045q, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →08.00.85t, Tocilizumab and Related Biosimilars for Intravenous InfusionMediumEffective Jul 1, 2026 · Pharmacy08.00.85s, Tocilizumab and Related Biosimilars for Intravenous InfusionMediumEffective Apr 1, 2026 · Pharmacy08.00.85u, Tocilizumab and Related Biosimilars for Intravenous InfusionHighEffective Sep 14, 2026 · Pharmacy08.00.85r, Tocilizumab and Related Biosimilars for Intravenous InfusionHighEffective Oct 1, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list