Medicare AdvantagePrior AuthMedium impact
MA08.100e, patisiran (Onpattro®) and vutrisiran (Amvuttra®)
Independence Blue Cross·Neurology, Cardiology, Nephrology·Pharmacy
Effective date
Aug 18, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.100e for patisiran (Onpattro®) and vutrisiran (Amvuttra®) has been updated with changes to medical necessity criteria, medical coding requirements, and general guidelines for these specialty medications used to treat hereditary transthyretin-mediated amyloidosis.
Action Required
By August 18, 2025: Billing team must review updated medical necessity criteria for patisiran (Onpattro®) and vutrisiran (Amvuttra®) by accessing the full policy at the IBX Medicare Advantage portal. Update prior authorization workflows and documentation requirements for these specialty medications. Ensure providers are aware of any new coding or coverage criteria changes that may affect claim approvals.