Medicare AdvantageCoverageMedium impact
MA08.121f, Pembrolizumab (Keytruda®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Apr 21, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.121f for Pembrolizumab (Keytruda®) has been updated with changes to medical necessity criteria and medical coding requirements. This affects billing and coverage determination for this cancer immunotherapy drug.
Action Required
By April 21, 2025: Billing team must review updated medical necessity criteria for Pembrolizumab (Keytruda®) claims and verify any new coding requirements. Update prior authorization workflows and documentation requirements for Medicare Advantage patients receiving this therapy. Ensure all claims meet the revised medical necessity standards to avoid denials.