Medicare AdvantageCoverageMedium impact
MA08.079m, Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Sep 22, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.079m for Daratumumab (Darzalex) and Daratumumab-hyaluronidase (Darzalex Faspro) has been updated with changes to medical necessity criteria, medical coding requirements, and general guidelines. This affects billing and coverage for these cancer medications used primarily in multiple myeloma treatment.
Action Required
Before September 22, 2025: Billing and clinical teams must review updated medical necessity criteria and coding requirements for Daratumumab (Darzalex) and Daratumumab-hyaluronidase (Darzalex Faspro). Access the full policy at the IBX medical policy portal to understand new documentation requirements and ensure compliance with updated guidelines for Medicare Advantage claims.