Medicare AdvantageCoverageLow impact
MA08.131c, Lumasiran (Oxlumo®)
Independence Blue Cross·Nephrology, Pediatrics, Endocrinology·Pharmacy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.131c for Lumasiran (Oxlumo®) has been updated with changes to coverage/reimbursement position, medical necessity criteria, and coding guidelines. This affects billing for this rare disease medication used to treat primary hyperoxaluria.
Action Required
By December 29, 2025: Review updated MA08.131c policy for Lumasiran (Oxlumo®) coverage criteria and coding requirements. Billing team should verify current prior authorization requirements and medical necessity documentation standards for Medicare Advantage plans before submitting claims for this medication.