Medicare AdvantagePrior AuthMedium impact
MA08.113g, Enfortumab vedotin-ejfv (Padcev®)
Independence Blue Cross·Oncology·Pharmacy
Effective date
Apr 20, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.113g for Enfortumab vedotin-ejfv (Padcev®) has been updated with changes to medical necessity criteria, medical coding requirements, and general guidelines. This affects billing and coverage determination for this oncology medication.
Action Required
By April 20, 2026: Billing team must review updated medical necessity criteria for Enfortumab vedotin-ejfv (Padcev®) and update prior authorization processes accordingly. Oncology providers should verify new documentation requirements and coding guidelines are incorporated into treatment protocols. Claims may be denied if new criteria are not met.