CommercialCoverageMedium impact
08.00.84m, Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris®) for intravenous administration
Independence Blue Cross·Hematology, Nephrology, Neurology·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Updated medical necessity criteria for Eculizumab (Soliris®), related biosimilars, and Ravulizumab-cwvz (Ultomiris®) intravenous administration. The policy establishes new requirements for coverage determination of these specialty pharmacy medications effective January 1, 2026.
Action Required
By December 31, 2025: Billing team must review and update prior authorization processes for Eculizumab (Soliris®) and Ravulizumab-cwvz (Ultomiris®) claims to align with new medical necessity criteria. Providers must ensure documentation meets updated requirements before administering these medications. Claims not meeting new criteria will be denied.