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MA08.045o, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection
Effective date
Jan 1, 2026
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated MA08.045o to MA08.045r effective 01/01/2026, expanding tocilizumab coverage criteria for COVID-19 to include pediatric patients aged 2 years and older, designating tocilizumab-aazg (Tyenne) as the preferred biosimilar product, and adding three new HCPCS codes (M0249, M0250, Q0249) retroactive to 06/24/2021. Billing teams must update systems to reflect the preferred product hierarchy and implement the new COVID-19 HCPCS codes.
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What to do
Action · 6 steps
01By 01/01/2026: Billing team must.
02Update billing software to reflect tocilizumab-aazg (Tyenne) and tocilizumab-anoh (Avtozma IV) as preferred products and enforce step-therapy requirements for nonpreferred tocilizumab products (Actemra, Tofidence, other biosimilars) requiring documentation of contraindication, intolerance, or inadequate prior response.
03Implement HCPCS codes M0249, M0250, and Q0249 for COVID-19 hospitalized patients aged 2 years and older receiving systemic corticosteroids with oxygen/ventilation/ECMO requirements, noting M0249 and M0250 are retroactive to 06/24/2021 for claims adjustment.
04Update claim scrubbing rules to prevent concurrent billing of tocilizumab with biologic DMARDs (TNF antagonists, IL-1R antagonists, anti-CD20 monoclonal antibodies, selective co-stimulation modulators).
05Train billing and prior authorization staff on pediatric eligibility (age 2+) for COVID-19 indications.
06Communicate preferred product designation to provider network to minimize claim denials from nonpreferred product submissions.
If missed: Failure to implement preferred product controls and new COVID-19 codes will result in claim denials and potential overpayments.
Codes mentioned
J3262M0233M0249M0250Q0249
Original notice
MA08.045o, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA08.045r, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous InjectionMediumEffective Sep 21, 2026 · PharmacyMA08.045q, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous InjectionMediumEffective Jul 1, 2026 · PharmacyMA08.045m, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous InjectionMediumEffective Jul 1, 2025 · PharmacyMA08.045p, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous InjectionMediumEffective Apr 1, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list