Medicare AdvantageCoverageMedium impact
MA08.098b, Tildrakizumab-asmn (Ilumya®)
Independence Blue Cross·Dermatology·Pharmacy
Effective date
Sep 14, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.098b for Tildrakizumab-asmn (Ilumya®) has been updated with changes to coverage, reimbursement, medical necessity criteria, and coding guidelines. This affects billing and coverage determination for this specialty biologic medication used primarily in dermatology.
Action Required
Before September 14, 2026: Billing and clinical teams must review updated coverage and medical necessity criteria for Tildrakizumab-asmn (Ilumya®). Update prior authorization workflows and documentation requirements per new policy guidelines. Verify any coding changes are implemented in billing systems to ensure proper reimbursement.