Medicare AdvantageAdministrativeMedium impact
MA08.100e, patisiran (Onpattro®) and vutrisiran (Amvuttra®)
Independence Blue Cross·Pharmacy, Hematology, Internal Medicine·Pharmacy
Effective date
Aug 18, 2025
We identified it
Jun 19, 2026
Summary
MA08.100e updates medical necessity criteria, medical coding guidelines, and informational requirements for patisiran (Onpattro®) and vutrisiran (Amvuttra®), two specialty pharmaceutical treatments for transthyretin (TTR) amyloidosis. This recent policy change (effective 08/18/2025) affects how these medications are billed, authorized, and documented for Medicare Advantage beneficiaries.
Action Required
By 08/18/2025: Billing team and clinical staff must review MA08.100e policy updates for patisiran and vutrisiran to understand any changes to medical necessity criteria and coding guidelines. Verify current prior authorization requirements in the billing system for these medications. Update any internal documentation templates or authorization workflows to reflect new criteria. Contact IBX (or applicable plan administrator) if specific HCPCS codes for these medications are not currently configured in your system. Failure to follow updated medical necessity criteria may result in claim denials.