CommercialPrior AuthLow impact
08.02.19a, Mirikizumab-mrkz (Omvoh®) for Intravenous Use
Independence Blue Cross·Gastroenterology, Internal Medicine·Pharmacy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
IBX has updated the medical necessity criteria for Mirikizumab-mrkz (Omvoh®), a specialty intravenous medication used primarily for inflammatory bowel disease. This pharmacy policy change affects prior authorization requirements and coverage criteria for this high-cost biologic therapy.
Action Required
By December 29, 2025: Billing team should review updated prior authorization requirements for Mirikizumab-mrkz (Omvoh®) prescriptions. Update prior auth workflows to reflect new medical necessity criteria. Inform providers who prescribe IBD medications of the updated coverage requirements to avoid claim denials.