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Independence Blue CrossMedicare Advantage · Coverage · Pharmacy · Rheumatology, Oncology, Infectious Disease +1 moreMedium impact

MA08.045m, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection

Act
by Jul 1, 2025
Effective date
Jul 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross Medicare Advantage Policy MA08.045r (effective 07/01/2025) adds tocilizumab-anoh (Avtozma) as a newly preferred biosimilar product with HCPCS codes C9399 and J3590. The policy also expands Castleman disease coverage to allow tocilizumab as a substitute for siltuximab during shortage/unavailability and updates immunotherapy-related toxicity criteria per NCCN guidelines. All ICD-10 codes were removed as informational only.

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What to do

by Jul 1, 2025 · 5 steps
01Billing team must update billing system to recognize new HCPCS codes C9399 and J3590 for tocilizumab-anoh (Avtozma IV) claims.
02Update preferred/non-preferred product lists in claims adjudication logic to include tocilizumab-anoh (Avtozma IV) as preferred alongside tocilizumab-aazg (Tyenne IV).
03Clinical/prior authorization staff must update step therapy protocols to allow tocilizumab as first-line for Castleman disease (multicentric) when siltuximab is unavailable or in shortage.
04Providers should be notified of expanded Castleman disease coverage criteria and siltuximab substitution option.
05Ensure billing system reflects that nonpreferred tocilizumab products (Actemra IV, Tofidence IV, other biosimilars) still require documentation of contraindication, intolerance, or inadequate response to preferred agents.
If missed: Failure to implement code recognition will result in claims rejection or manual review delays.

Codes mentioned

J3262M0233C9399J3590

Original notice

MA08.045m, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA08.045n, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous InjectionMediumEffective Jan 24, 2025 · Pharmacy08.00.85r, Tocilizumab and Related Biosimilars for Intravenous InfusionHighEffective Oct 1, 2025 · PharmacyMA08.172, Lifileucel (Amtagvi™)LowEffective Oct 21, 2024 · Pharmacy08.02.22, Lifileucel (Amtagvi™)LowEffective Oct 21, 2024 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesRheumatologyOncologyInfectious DiseasePharmacyCode J3262Code M0233Code C9399Code J3590

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