CommercialPrior AuthMedium impact
08.02.19a, Mirikizumab-mrkz (Omvoh®) for Intravenous Use
Independence Blue Cross·Gastroenterology, Rheumatology·Pharmacy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
This policy establishes medical necessity criteria for Mirikizumab-mrkz (Omvoh®), an intravenous pharmaceutical treatment. The billing team must implement prior authorization requirements and ensure claims include appropriate medical necessity documentation before processing.
Action Required
By December 29, 2025: Billing team must implement prior authorization requirement for Mirikizumab-mrkz (Omvoh®) IV infusions in the billing system. Update claim submission workflows to require medical necessity documentation per policy 08.02.19a before processing claims. Coordinate with clinical staff to ensure providers document medical necessity criteria on all Omvoh® orders. Claims submitted without prior authorization or required documentation will be denied.