Medicare AdvantageCoverageMedium impact
MA08.179a, Guselkumab (Tremfya®) Injection for Intravenous Use
Independence Blue Cross·Dermatology, Rheumatology·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.179a for Guselkumab (Tremfya®) injection for intravenous use has been updated with changes to medical necessity criteria and general guidelines. This affects coverage and authorization requirements for this specialty biologic medication used primarily in dermatology and rheumatology.
Action Required
By July 1, 2025: Review updated medical necessity criteria for Guselkumab (Tremfya®) intravenous injection claims. Billing team must verify current prior authorization requirements and update any internal guidelines for Medicare Advantage plans. Providers should ensure documentation meets revised medical necessity criteria to avoid claim denials.