Medicare AdvantageCoverageMedium impact
MA08.015e, Alemtuzumab (Lemtrada®)
Independence Blue Cross·Neurology, Pharmacy, Oncology·Pharmacy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Policy MA08.015e establishes Medicare Advantage coverage guidelines for Alemtuzumab (Lemtrada®), a disease-modifying therapy for multiple sclerosis. This recent policy (1 month old, effective 10/01/2025) requires billing and clinical teams to align claims submission and prior authorization processes with updated Medicare Advantage requirements for this specialty pharmaceutical.
Action Required
By October 1, 2025 (or immediately if past this date): Billing and clinical teams must obtain and review the complete policy text at https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=10&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#medicare-advantage-ma08-015e-alemtuzumab-lemtrada to identify specific coverage criteria, prior authorization requirements, and applicable HCPCS codes for Alemtuzumab administration. Update billing system rules, prior authorization templates, and provider order entry workflows to enforce policy requirements. Ensure all claims for Alemtuzumab submitted to Medicare Advantage plans include proper prior authorization documentation. Train providers and billing staff on coverage limitations and medical necessity documentation requirements. Failure to comply may result in claim denials and recoupment.