Medicare AdvantageCoverageMedium impact
MA08.179, Guselkumab (Tremfya®) Injection for Intravenous Use
Independence Blue Cross·Rheumatology, Dermatology, Gastroenterology·Pharmacy
Effective date
Mar 24, 2025
We identified it
Jun 19, 2026
Summary
A new Medicare Advantage policy MA08.179 has been established for Guselkumab (Tremfya®) injection for intravenous use, effective March 24, 2025. This new pharmacy policy will likely establish coverage criteria and requirements for this specialty biologic medication used primarily for inflammatory conditions.
Action Required
By March 24, 2025: Billing and clinical teams should review the full policy details at the provided URL to understand coverage criteria, prior authorization requirements, and billing guidelines for Guselkumab (Tremfya®) injections. Update internal protocols and verify patient eligibility before administering this medication to Medicare Advantage members.