Medicare AdvantageCoverageMedium impact
MA08.098b, Tildrakizumab-asmn (Ilumya®)
Independence Blue Cross·MA · Dermatology, Rheumatology·Pharmacy
Effective date
Sep 14, 2026
We identified it
Jun 19, 2026
Summary
Policy MA08.098b updates coverage and reimbursement criteria, medical necessity requirements, and medical coding guidelines for Tildrakizumab-asmn (Ilumya®), a biologic treatment for psoriasis. This recent policy change affects how claims are coded, authorized, and reimbursed effective September 14, 2026.
Action Required
By September 14, 2026: Billing and clinical teams must review the complete MA08.098b policy document to identify specific billing codes, prior authorization requirements, and medical necessity documentation criteria for Ilumya® claims. Update billing system rules, prior authorization workflows, and provider documentation templates accordingly. Access the full policy at https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=06&FilterField2=MPSiteActivityLogYear&FilterValue2=2026#medicare-advantage-ma08-098b-tildrakizumab-asmn-ilumya to extract specific HCPCS codes and requirements. Claims submitted without updated coding or required documentation will be denied or delayed.