Medicare AdvantageCoverageMedium impact
MA08.098b, Tildrakizumab-asmn (Ilumya®)
Independence Blue Cross·Dermatology, Pharmacy·Pharmacy
Effective date
Sep 14, 2026
We identified it
Sep 15, 2026
Summary
Policy MA08.098b updates coverage and reimbursement criteria for Tildrakizumab-asmn (Ilumya®), a biologic medication for psoriasis. The policy includes changes to medical necessity criteria, billing codes, and general coverage guidelines effective September 14, 2026. The billing team must review the full policy document to identify specific code changes and prior authorization requirements.
Action Required
By September 14, 2026: Billing and clinical teams must obtain and review the complete MA08.098b policy document from the source URL to identify: (1) specific HCPCS J-codes for Tildrakizumab-asmn administration, (2) updated medical necessity criteria for prior authorization, (3) any changes to billing code requirements. Update billing system templates, prior authorization workflows, and provider documentation requirements accordingly. Do not process claims for Ilumya® without confirming alignment with updated medical necessity criteria, as claims may be denied if submitted under outdated guidelines.