Medicare AdvantageCoverageMedium impact
MA08.022t, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Independence Blue Cross·Oncology, Hematology, Rheumatology·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage updated their policy for Rituximab (Rituxan) infusion, biosimilars, and subcutaneous injection coverage and reimbursement positions, along with medical coding changes. This affects how these cancer and autoimmune medications are billed and covered.
Action Required
Before January 1, 2026: Billing team must review and implement updated coverage criteria and coding requirements for Rituximab (Rituxan) infusions, biosimilars, and Rituxan Hycela subcutaneous injections for Medicare Advantage patients. Update billing software rules and prior authorization workflows as specified in the full policy. Verify current coding practices align with new requirements to prevent claim denials.