CommercialCoverageMedium impact
08.01.29m, Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Sep 22, 2025
We identified it
Jun 19, 2026
Summary
Insurance policy for Daratumumab (Darzalex) and Daratumumab and Hyaluronidase-fihj (Darzalex Faspro) has been updated with changes to medical necessity criteria, medical coding requirements, and general guidelines. This affects how these cancer medications are billed and what documentation is required for coverage approval.
Action Required
Before September 22, 2025: Billing team must review updated medical necessity criteria and coding requirements for Daratumumab medications. Update prior authorization workflows and ensure providers are aware of new documentation requirements. Monitor for specific billing codes and coverage criteria once full policy details are available.