Medicare AdvantageCoverageMedium impact
MA08.033d, Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio)
Independence Blue Cross·Genetics, Nephrology, Cardiology·Medical Policy
Effective date
May 28, 2025
We identified it
Jun 19, 2026
Summary
Policy MA08.033d has been reissued effective 05/28/2025 regarding coverage and billing for Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio), which are enzyme replacement therapies for Fabry disease. The billing team must review the full policy text to identify specific coverage criteria, prior authorization requirements, and any changes to billing procedures for these specialty medications.
Action Required
By 05/28/2025: Billing team must obtain and review the complete MA08.033d policy document from the provided source URL to identify: (1) specific HCPCS codes for Fabrazyme and Elfabrio, (2) prior authorization requirements, (3) coverage limitations or restrictions, and (4) documentation requirements. Update billing software, prior authorization workflows, and provider education materials accordingly. Communicate any changes to providers and front desk staff. Failure to implement required prior authorization may result in claim denials.