Medicare AdvantageCoverageMedium impact
MA08.036g, Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ )
Independence Blue Cross·Endocrinology, Neurology, Pediatrics·Pharmacy
Effective date
Nov 26, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.036g for specialized enzyme replacement therapies (Lumizyme, Nexviazyme, Pombiliti) has been reissued with an effective date of November 26, 2025. This policy covers rare disease treatments for Pompe disease and requires review of current coverage and billing procedures.
Action Required
Before November 26, 2025: Billing team must review updated Medicare Advantage policy MA08.036g for enzyme replacement therapies (Lumizyme, Nexviazyme, Pombiliti). Access full policy details at the source URL to determine any changes to prior authorization requirements, coverage criteria, or billing procedures for these specialty medications.