Medicare AdvantagePrior AuthMedium impact
MA08.066h, Ado-Trastuzumab Emtansine (Kadcyla®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Nov 17, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.066h for Ado-Trastuzumab Emtansine (Kadcyla®) has been updated with changes to medical necessity criteria and medical coding requirements. This affects oncology practices that prescribe or administer this cancer medication.
Action Required
By November 17, 2025: Oncology billing teams must review and implement updated medical necessity criteria for Kadcyla® (Ado-Trastuzumab Emtansine) claims for Medicare Advantage patients. Update prior authorization workflows and documentation requirements according to the new policy MA08.066h. Verify medical coding changes are applied in billing system to ensure compliance with updated criteria.