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MA08.151d, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease
Effective date
Not stated in the notice
Identified
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage policy MA08.151d for amyloid-directed monoclonal antibodies (aducanumab, lecanemab, donanemab) has been superseded by version MA08.151e. The policy reiterates that these drugs remain experimental/investigational and NOT covered except through CMS Coverage with Evidence Development (CED) programs for Medicare Advantage members enrolled in approved clinical trials. A new HCPCS code (J0175 for donanemab-azbt) was added in July 2024, and FDA approval of donanemab (Kisunla) in July 2024 is documented.
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What to do
Action · 5 steps
01REQUIREMENTS:
- Billing team: Ensure billing system recognizes HCPCS code J0175 (donanemab-azbt, 2 mg) for claims submitted on or after 07/02/2024.
02- Verify that claims for J0172 (aducanumab), J0174 (lecanemab), or J0175 (donanemab) are ONLY submitted when members are enrolled in a CMS-approved CED clinical trial; otherwise, claims will be denied as experimental/investigational.
03- Prior Authorization team: Route all amyloid monoclonal antibody requests to verify CED trial enrollment status before authorizing.
04Rejection guidance: "Not covered outside of CED clinical trial enrollment."
- Claims Processing: Flag any claims for these three drugs without CED trial documentation for denial with message referencing coverage limitation to CED programs only.
05- Providers: Educate ordering physicians that these medications are limited to CED trial participants; routine office-based prescriptions will not be covered.
Codes mentioned
J0172J0174J0175G30.0G30.1G30.8G30.9G31.84
Original notice
MA08.151d, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA08.151d, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's DiseaseMediumEffective Mar 5, 2025 · Medical PolicyMA08.151e, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's DiseaseMediumEffective Jan 1, 2026 · Medical Policy08.01.93e, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer DiseaseHighEffective Jan 1, 2025 · Medical Policy08.01.93e, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer DiseaseMediumEffective Jan 1, 2025 · Medical PolicyBrowse every Independence Blue Cross change in the policy list