Medicare AdvantageCoverageMedium impact
MA08.036g, Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ )
Independence Blue Cross·Endocrinology, Neurology, Pediatrics·Pharmacy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.036g for enzyme replacement therapies (Lumizyme, Nexviazyme, Pombiliti) has been reissued with updates effective April 1, 2026. This affects coverage and billing requirements for patients with Pompe disease receiving these specialized treatments.
Action Required
Before April 1, 2026: Review updated policy MA08.036g for changes to coverage criteria, prior authorization requirements, or documentation standards for alglucosidase alfa, avalglucosidase alfa-ngpt, and cipaglucosidase alfa-atga. Billing team should access the full policy at the provided URL to identify specific changes and update billing procedures accordingly.