Medicare AdvantagePrior AuthMedium impact
MA07.025g, Intrauterine Systems (IUSs) (e.g., Mirena®, Skyla®, Liletta®, Kyleena®)
Independence Blue Cross·OB-GYN, Pharmacy·Pharmacy
Effective date
Dec 28, 2023
We identified it
Jun 19, 2026
Summary
Policy MA07.025g updates medical necessity criteria for intrauterine systems (IUSs) including Mirena, Skyla, Liletta, and Kyleena effective 12/28/2023. This is a recent pharmacy policy change affecting coverage and authorization requirements for these contraceptive devices on Medicare Advantage plans.
Action Required
By 06/28/2025 (30 days from policy posting): Billing and clinical teams must review the full policy text at the provided URL to identify specific medical necessity criteria changes. Update prior authorization workflows, encounter documentation templates, and billing system rules to reflect new criteria for IUS coverage. Coordinate with providers to ensure all IUS claims include required medical necessity documentation. Claims submitted without compliance to new criteria will face denials. Contact the plan at the policy URL for specific coding guidance if not included in full text.