CommercialCoverageMedium impact
08.01.74c, Lumasiran (Oxlumo®)
Independence Blue Cross·Nephrology, Pediatrics, Internal Medicine·Pharmacy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
Insurance policy 08.01.74c for Lumasiran (Oxlumo®) has been updated with changes to coverage criteria, medical necessity requirements, and billing codes. This affects pharmacy benefits for this rare disease medication used to treat primary hyperoxaluria.
Action Required
By December 29, 2025: Review updated policy 08.01.74c at the provided URL to understand specific changes to Lumasiran coverage criteria and medical necessity requirements. Update prior authorization procedures and billing protocols for Oxlumo® prescriptions according to new guidelines. Ensure providers are aware of any new documentation requirements for this rare disease treatment.