Medicare AdvantageCoverageMedium impact
MA08.117e, Isatuximab-irfc (Sarclisa®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Mar 24, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.117e for Isatuximab-irfc (Sarclisa®) has been updated with changes to medical necessity criteria, medical coding requirements, and general guidelines. This affects coverage and billing requirements for this cancer immunotherapy drug used primarily in multiple myeloma treatment.
Action Required
By March 24, 2025: Billing team must review updated medical necessity criteria for Isatuximab-irfc (Sarclisa®) claims. Update prior authorization requirements and coding guidelines in billing system for Medicare Advantage patients receiving this immunotherapy. Ensure providers document updated medical necessity requirements to prevent claim denials.