Medicare AdvantagePrior AuthMedium impact
MA08.068l, Brentuximab Vedotin (Adcetris®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Oct 20, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.068l for Brentuximab Vedotin (Adcetris®) has been updated with changes to medical necessity criteria, medical coding requirements, and general guidelines. This affects billing and coverage determination for this specialty oncology medication used primarily for lymphoma treatment.
Action Required
By October 20, 2025: Billing and clinical teams must review updated medical necessity criteria for Brentuximab Vedotin (Adcetris®) claims. Update prior authorization workflows and documentation requirements per the new policy guidelines. Ensure coding practices align with revised medical coding criteria to prevent claim denials for Medicare Advantage patients.