CommercialCoverageMedium impact
08.00.91f, Alpha-1 Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)
Independence Blue Cross·Pulmonology, Pharmacy, Internal Medicine·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.00.91f updates medical necessity criteria for Alpha-1 Antitrypsin (AAT) therapy products (Prolastin-C, Aralast NP, Glassia, Zemaira). This is a recent pharmacy policy change effective July 1, 2025 that modifies coverage requirements. The billing team must understand the new medical necessity criteria to ensure claims are submitted with appropriate documentation and meet coverage guidelines.
Action Required
By July 1, 2025: Billing and clinical teams must review the complete medical necessity criteria in policy 08.00.91f and ensure all AAT therapy claims include supporting documentation that meets the new requirements. Update claim submission checklists and provider encounter templates to capture required clinical documentation. Contact the policy source at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=07&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-00-91f to obtain the specific medical necessity criteria details. Train billing staff on the updated requirements before the effective date. Monitor initial claim submissions for denials related to medical necessity and adjust documentation processes accordingly.