Medicare AdvantageCoverageMedium impact
MA08.169a, Mirikizumab-mrkz (Omvoh®) for Intravenous Use
Independence Blue Cross·Gastroenterology, Internal Medicine·Pharmacy
Effective date
Mar 16, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated medical necessity criteria for Mirikizumab-mrkz (Omvoh®), an intravenous medication used for inflammatory bowel conditions. The new criteria will take effect March 16, 2026, potentially changing prior authorization requirements or coverage conditions for this specialty drug.
Action Required
Before March 16, 2026: Billing team and providers must review updated medical necessity criteria for Mirikizumab-mrkz (Omvoh®) at the source URL. Update prior authorization workflows and ensure documentation meets new criteria requirements. Verify coverage requirements with Medicare Advantage plans before administering this medication to avoid claim denials.