CommercialCoverageMedium impact
Preventive Coverage of Clesrovimab (Enflonsia) for Commercial Members (Retroactively Effective 08/04/2025)
Independence Blue Cross·Allergy & Immunology, Infectious Disease, Pediatrics·News & Announcements
Effective date
Aug 4, 2025
We identified it
Jun 19, 2026
Summary
This policy establishes preventive coverage for Clesrovimab (Enflonsia) for commercial members, effective retroactively as of August 4, 2025. The billing team must update systems to recognize this medication as a covered preventive service and ensure claims are processed appropriately under preventive benefits rather than standard pharmacy or medical benefits.
Action Required
By September 30, 2025: Billing team must update pharmacy and medical billing systems to classify Clesrovimab (Enflonsia) as a covered preventive service for all commercial members. Coordinate with pharmacy benefit manager (PBM) to ensure claims submitted on or after August 4, 2025 are processed with preventive (zero copay) benefits rather than standard formulary placement. Resubmit any claims for this medication from August 4, 2025 forward that were previously denied or processed with patient cost-sharing. Notify providers in affected specialties of the retroactive coverage effective date. Failure to update systems may result in incorrect patient cost-sharing and potential claim adjustments.