Medicare AdvantagePrior AuthMedium impact
MA08.169a, Mirikizumab-mrkz (Omvoh®) for Intravenous Use
Independence Blue Cross·MA · Gastroenterology, Rheumatology·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. The billing team must review updated coverage requirements and implement prior authorization procedures for this biologic therapy. This policy applies to Medicare Advantage plans only.
Action Required
Before March 16, 2026: Billing team must obtain and review the complete MA08.169a policy details to identify specific medical necessity criteria, prior authorization requirements, and covered diagnoses for Mirikizumab-mrkz (Omvoh®). Update billing system to enforce prior authorization workflow for this drug. Coordinate with providers to ensure documentation aligns with new medical necessity criteria. Training required for billing and prior authorization staff. Contact plan administrator at https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=12&FilterField2=MPSiteActivityLogYear&FilterValue2=2025 for full policy details if not already received. Claims submitted without prior authorization may be denied.