CommercialPrior AuthMedium impact
08.01.50e, Patisiran (Onpattro®) and vutrisiran (Amvuttra®)
Independence Blue Cross·Neurology, Cardiology, Gastroenterology·Pharmacy
Effective date
Aug 18, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.01.50e for Patisiran (Onpattro®) and vutrisiran (Amvuttra®) has been updated with changes to medical necessity criteria, medical coding, and general guidelines. This affects commercial plans and involves pharmacy benefit coverage for these specialty medications used to treat hereditary transthyretin-mediated amyloidosis.
Action Required
By August 18, 2025: Billing team must review updated medical necessity criteria for Patisiran (Onpattro®) and vutrisiran (Amvuttra®) prescriptions. Update prior authorization workflows and ensure providers document compliance with new medical necessity requirements. Verify coding guidelines are current in billing system for these specialty pharmacy benefits.