Medicare AdvantageCoverageHigh impact
MA08.007au, Medicare Part B vs. Part D Crossover Drugs
Independence Blue Cross·Pharmacy·Pharmacy
Effective date
Mar 30, 2026
We identified it
Jun 19, 2026
Summary
Policy MA08.007au clarifies Medicare Part B vs. Part D crossover drug coverage and reimbursement distinctions for Medicare Advantage plans. This policy establishes which drugs are covered under Part B pharmacy benefits versus Part D prescription drug benefits, affecting how claims are submitted and reimbursed.
Action Required
By March 30, 2026: Billing team must review and update claim submission protocols to correctly identify whether crossover drugs should be billed under Part B or Part D based on MA08.007au guidance. Update billing system edits and clinical decision support rules to route crossover drug claims to the appropriate benefit. Pharmacy staff must verify drug classification before processing. Contact MA plan for specific drug classification lists if not provided in full policy text. Claims submitted to wrong benefit will be denied or rejected.