Medicare AdvantagePrior AuthMedium impact
MA08.169a, Mirikizumab-mrkz (Omvoh®) for Intravenous Use
Independence Blue Cross·Gastroenterology, Rheumatology, Oncology·Pharmacy
Effective date
Mar 16, 2026
We identified it
Jun 19, 2026
Summary
MA08.169a updates medical necessity criteria for Mirikizumab-mrkz (Omvoh®) intravenous infusions effective March 16, 2026. This policy change affects prior authorization requirements and coverage determinations for this biologic therapy. Billing teams must review updated criteria to ensure claims meet new medical necessity standards.
Action Required
By March 16, 2026: Billing and clinical teams must obtain and review the complete updated medical necessity criteria for Mirikizumab-mrkz (Omvoh®) from the policy source. Update prior authorization workflows and claim submission processes to align with new criteria. Verify that all Mirikizumab-mrkz claims submitted on or after the effective date include documentation supporting the updated medical necessity requirements. Failure to comply with new criteria will result in claim denials. Contact the plan at https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=03&FilterField2=MPSiteActivityLogYear&FilterValue2=2026 for full policy details.