Medicare AdvantageCoverageHigh impact
MA08.079n, Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)
Independence Blue Cross·Oncology, Hematology, Pharmacy·Pharmacy
Effective date
Aug 24, 2026
We identified it
Aug 25, 2026
Summary
Policy MA08.079n has been updated effective 08/24/2026 regarding coverage and medical necessity criteria for Daratumumab (Darzalex®) and Daratumumab with Hyaluronidase-fihj (Darzalex Faspro®). This is a fresh policy update affecting pharmacy coverage and reimbursement positions. Billing teams must review the specific coverage and medical necessity requirements to ensure claims are submitted with appropriate documentation and authorization.
Action Required
By 08/24/2026: Billing and pharmacy teams must obtain and review the complete policy text for MA08.079n to identify specific coverage criteria, prior authorization requirements, and medical necessity documentation needed for Daratumumab (Darzalex®) and Daratumumab/Hyaluronidase-fihj (Darzalex Faspro®) claims. Update billing system rules and prior authorization workflows accordingly. Coordinate with providers and pharmacy to ensure all claims submitted after 08/24/2026 include required medical necessity documentation. Failure to comply with updated coverage and medical necessity criteria will result in claim denials. The policy URL is provided for accessing full policy details.