Medicare AdvantageCoverageMedium impact
MA08.182, Zanidatamab-hrii (Ziihera®)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Apr 21, 2025
We identified it
Jun 19, 2026
Summary
MA08.182 is a new Medicare Advantage policy establishing coverage and billing guidelines for Zanidatamab-hrii (Ziihera®), a bispecific antibody cancer therapeutic. This policy is effective immediately and requires billing teams to implement proper coding, prior authorization, and medical necessity documentation for this new drug.
Action Required
By April 21, 2025: Billing team must obtain and review the full policy text for MA08.182 Zanidatamab-hrii (Ziihera®) from https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=04&FilterField2=MPSiteActivityLogYear&FilterValue2=2025. Update billing system to include this new drug with appropriate HCPCS J-code assignment, prior authorization requirements, and coverage criteria. Ensure pharmacy and oncology staff are trained on documentation requirements and submission procedures. Confirm whether prior authorization is required before dispensing and communicate requirements to prescribing providers. Without proper implementation, claims will be denied.