CommercialDocumentationMedium impact
08.02.33a, Guselkumab (Tremfya®) Injection for Intravenous Use
Independence Blue Cross·Dermatology, Rheumatology, Internal Medicine·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.02.33a updates medical necessity criteria for Guselkumab (Tremfya®) Injection effective July 1, 2025. The policy change modifies coverage guidelines and general description/informational requirements for this intravenous biologic medication. Billing teams must review updated medical necessity documentation requirements and prior authorization procedures to ensure compliant claim submission.
Action Required
By July 1, 2025: Billing team and prior authorization staff must obtain and review the complete policy text at the provided URL to identify specific medical necessity criteria changes for Guselkumab (Tremfya®). Update prior authorization submission requirements and clinical documentation checklists accordingly. Providers should be notified of any new documentation requirements needed to support coverage. Verify billing system is configured to route claims through updated prior auth process. Claims submitted without compliance to new medical necessity criteria may be denied.