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Independence Blue CrossMedicare Advantage · Coverage · Pharmacy · PA · Dermatology, Rheumatology, Gastroenterology +1 moreMedium impact

MA08.007ax, Medicare Part B vs. Part D Crossover Drugs

Effective date
Aug 30, 2026
Identified
Sep 22, 2026

Summary

Independence Blue Cross updated policy MA08.007ax to MA08.007ay, effective 08/30/2026, adding two drugs to Part D-only coverage (excluded from Part B): bimekizumab-bkzx (Bimzelx) and ustekinumab-hmny (Starjemza). Bimzelx claims should route to Part D pharmacy benefit; Starjemza requires a JB modifier when administered subcutaneously. Billing teams must update systems to prevent incorrect Part B billing for these self-administered drugs.

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What to do

Action · 5 steps
01By 08/30/2026: Billing team must update billing system to route all claims for bimekizumab-bkzx (Bimzelx) and ustekinumab-hmny (Starjemza) to Part D pharmacy benefit only—DO NOT bill Part B.
02For Starjemza (Q5164) administered subcutaneously, append JB modifier to claims.
03Update internal policy references from MA08.007ax to MA08.007ay in all documentation and system configurations.
04Train billing staff that these drugs are now excluded from Part B coverage regardless of administration setting.
05Notify prescribing providers that these drugs must be dispensed through Part D pharmacy benefit.
If missed: Failure to route to Part D will result in claim denials under Part B.

Codes mentioned

C9399J3490J3590Q5164

Original notice

MA08.007ax, Medicare Part B vs. Part D Crossover Drugs
medpolicy.ibx.com · Always check the source before changing claims.
View original ↗

Related changes

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Related policy hubs

Independence Blue Cross policiesPA policy changesDermatologyRheumatologyGastroenterologyPharmacyCode C9399Code J3490Code J3590Code Q5164

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