Medicare AdvantagePrior AuthMedium impact
MA08.024n, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Exdensur, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)
Independence Blue Cross·Pulmonology, Allergy & Immunology, Internal Medicine·Pharmacy
Effective date
Mar 23, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.024n for IL-5 antagonist medications (Cinqair, Nucala, Fasenra) has been updated with changes to medical necessity criteria, medical coding, and general guidelines. This affects coverage and billing requirements for these specialty asthma/eosinophilic disorder medications.
Action Required
Before March 23, 2026: Billing team must review updated medical necessity criteria for IL-5 antagonist medications including Cinqair, Nucala, and Fasenra. Update prior authorization processes and documentation requirements according to new policy guidelines. Verify any coding changes are reflected in billing system. Claims may be denied if new criteria are not met.