Medicare AdvantagePrior AuthMedium impact
MA08.019o, Intravenous Infliximab and Related Biosimilars
Independence Blue Cross·MA · Rheumatology, Gastroenterology, Allergy & Immunology +1 more·Pharmacy
Effective date
Apr 21, 2025
We identified it
Jun 19, 2026
Summary
Policy MA08.019o updates medical necessity criteria for intravenous infliximab and related biosimilars effective 04/21/2025. This recent change may affect prior authorization requirements, documentation standards, or coverage parameters for infliximab infusions and biosimilar alternatives. The billing team must review the full policy text to identify specific criteria changes and update authorization workflows accordingly.
Action Required
By 04/21/2025: Billing team and prior authorization staff must obtain and review the full policy text at the source URL to identify specific medical necessity criteria changes for infliximab and biosimilars. Update prior authorization templates, clinical criteria documentation requirements, and billing software rules to reflect new requirements. Notify providers in rheumatology, gastroenterology, and immunology departments of any documentation or approval process changes. Confirm all infliximab claims submitted after 04/21/2025 comply with updated medical necessity criteria to avoid denials.