Medicare AdvantagePrior AuthMedium impact
MA08.169a, Mirikizumab-mrkz (Omvoh®) for Intravenous Use
Independence Blue Cross·Gastroenterology, Rheumatology, Dermatology·Pharmacy
Effective date
Mar 16, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage plans are implementing new medical necessity criteria for Mirikizumab-mrkz (Omvoh®), a specialty medication used for intravenous administration. This change will likely require prior authorization or enhanced documentation requirements for this specific drug.
Action Required
By March 16, 2026: Billing team and providers must review and implement new medical necessity criteria for Mirikizumab-mrkz (Omvoh®) prescriptions. Update prior authorization workflows and ensure proper documentation of medical necessity is obtained before administering this IV medication to Medicare Advantage patients. Access the full policy at the provided URL to understand specific requirements.