Medicare AdvantageCoverageMedium impact
MA08.112a, Givosiran (Givlaari) and Panhematin (Hemin)
Independence Blue Cross·Hematology, Internal Medicine·Medical Policy
Effective date
May 19, 2025
We identified it
Jun 19, 2026
Summary
Policy MA08.112a updates medical necessity criteria, medical coding, and general guidelines for Givosiran (Givlaari) and Panhematin (Hemin). This is a recent update (1 month old) affecting how these specialty medications are billed and authorized on Medicare Advantage plans. The billing team must review the updated medical necessity criteria and coding requirements to ensure compliant claim submission.
Action Required
By June 19, 2025: Billing team must obtain and review the full policy text for MA08.112a at the provided URL to identify specific medical necessity criteria, updated coding guidelines, and any prior authorization requirements for Givosiran (Givlaari) and Panhematin (Hemin) claims. Update billing software, prior authorization workflows, and clinical documentation requirements accordingly. Ensure providers understand new medical necessity documentation standards. Flag any claims submitted before policy review for potential rework. Without proper implementation, Medicare Advantage claims for these medications may be denied for non-compliance with updated criteria.