Medicare AdvantageCoverageMedium impact
MA08.176a, Tarlatamab-dlle (Imdelltra® for intravenous use
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Jun 15, 2026
We identified it
Jun 19, 2026
Summary
This policy establishes medical necessity criteria for Tarlatamab-dlle (Imdelltra®), a new intravenous pharmaceutical agent. The policy change affects how claims for this medication will be processed under Medicare Advantage plans, likely requiring documentation of specific clinical criteria to support coverage and payment.
Action Required
By June 15, 2026: Billing team must review and implement the specific medical necessity criteria outlined in policy MA08.176a before processing any Tarlatamab-dlle (Imdelltra®) claims. Oncology providers must document that patients meet all criteria in the policy when ordering this medication. Update billing system to require documentation of medical necessity before claim submission. Pharmacy staff should verify patient eligibility against policy criteria. Claims submitted without proper medical necessity documentation will be denied by Medicare Advantage plans.