Medicare AdvantageCoverageMedium impact
MA08.024m, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)
Independence Blue Cross·Pulmonology, Allergy & Immunology·Pharmacy
Effective date
Mar 24, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage updated its policy for IL-5 and IL-5 receptor antagonist medications (Cinqair, Nucala, Fasenra) with changes to medical necessity criteria, medical coding requirements, and general guidelines. This affects billing and coverage determination for these specialty asthma/COPD medications.
Action Required
By March 24, 2025: Billing team must review updated medical necessity criteria for IL-5 antagonist medications (Cinqair, Nucala, Fasenra) in Medicare Advantage plans. Update prior authorization workflows and ensure documentation meets new criteria. Review coding guidelines for any changes to billing requirements for these specialty medications.