Medicare AdvantageCoverageMedium impact
MA08.175, Nogapendekin alfa inbakicept-pmln (Anktiva®)
Independence Blue Cross·Pharmacy, Oncology·Pharmacy
Effective date
Apr 21, 2025
We identified it
Jun 19, 2026
Summary
MA08.175 is a new Medicare Advantage pharmacy policy establishing coverage criteria for Nogapendekin alfa inbakicept-pmln (Anktiva®), a newly approved immunotherapy agent. The billing team must implement this policy immediately to ensure proper claim processing and authorization for this medication when prescribed to eligible Medicare Advantage members.
Action Required
By April 21, 2025: Pharmacy and billing teams must review full policy details at the provided URL to identify coverage criteria, prior authorization requirements, and any applicable HCPCS drug codes for Anktiva®. Update billing system with coverage rules and prior auth workflows. Communicate with prescribing providers about any documentation or approval requirements before dispensing. Flag any claims for this medication submitted before reviewing the complete policy for compliance verification.