Medicare AdvantageCoverageMedium impact
MA08.033d, Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio)
Independence Blue Cross·Internal Medicine, Nephrology, Genetics·Medical Policy
Effective date
Mar 4, 2026
We identified it
Jun 19, 2026
Summary
Policy MA08.033d has been reissued effective 03/04/2026 regarding coverage and billing for Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio), which are enzyme replacement therapies for Fabry disease. The billing team must review the complete policy text to identify specific coverage criteria, prior authorization requirements, and billing code changes that may affect claims processing for these specialty medications.
Action Required
By 03/04/2026: Billing team must access the complete policy text at the provided URL to extract specific coverage requirements, prior authorization mandates, and billing codes for Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio). Update billing software rules, prior authorization protocols, and pharmacy/specialty medication workflows accordingly. Communicate any changes to providers and pharmacy staff. Ensure all claims submitted on or after 03/04/2026 comply with reissued policy requirements. Without proper implementation, claims for these therapies will be processed under outdated guidelines and may be subject to denial or reconsideration.