Medicare AdvantagePrior AuthMedium impact
MA08.109c, crizanlizumab-tmca (Adakveo®)
Independence Blue Cross·Hematology, Oncology·Pharmacy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.109c for crizanlizumab-tmca (Adakveo®) has been updated with changes to medical necessity criteria, medical coding requirements, and general guidelines. This affects billing and coverage determination for this specialty medication used to treat sickle cell disease.
Action Required
By July 28, 2025: Review updated policy MA08.109c for crizanlizumab-tmca (Adakveo®) medical necessity criteria and coding requirements. Update prior authorization processes and documentation requirements for Medicare Advantage patients receiving this medication. Ensure providers are aware of new guidelines for prescribing and billing this specialty drug.