Updated Aug 23, 2026 · from snapshot diffs of the CMS coverage & SAD articles
Coverage updates feed
Drugs and diagnoses that changed since our last refresh.
| Date | Area | Drug | What changed |
|---|---|---|---|
| Sep 21, 2026 | Coverage | Sandostatin LAR | Coverage page added (72 covered diagnoses) |
| Aug 30, 2026 | Part B / Part D (SAD) | Bimzelx (bimekizumab-bkzx) | Added to SAD exclusions (Excluded) |
| Aug 30, 2026 | Part B / Part D (SAD) | Starjemza (ustekinumab-hmny) | Added to SAD exclusions (Route-dependent) |
| Aug 23, 2026 | Coverage | Ocrevus | Covered diagnoses 10 → 6 |
| Aug 23, 2026 | Coverage | Ocrevus Zunovo | Covered diagnoses 2 → 6 |
| Aug 23, 2026 | Coverage | Briumvi | Covered diagnoses 2 → 3 |
| Aug 23, 2026 | Part B / Part D (SAD) | Risankizumab-rzaa (Skyrizi™) This can also be billed with J3490 or C9399 as well as J3590. | Route-dependent → Excluded |
| Jun 15, 2026 | Part B / Part D (SAD) | nemolizumab-ilto (Nemluvio) Can alos be billed with code J3490 and C9399 | Added to SAD exclusions (Excluded) |
| Nov 15, 2025 | Part B / Part D (SAD) | Belimumab Benlysta | Route-dependent |
| Aug 31, 2025 | Part B / Part D (SAD) | Inj ustekinumab-srlf, 1 mg | Route-dependent |
| Aug 31, 2025 | Part B / Part D (SAD) | Inj ustekinumab-kfce, 1 mg | Route-dependent |
| Jul 1, 2025 | Part B / Part D (SAD) | Inj ustekinumab-stba, 1 mg | Route-dependent |
| Jun 30, 2025 | Part B / Part D (SAD) | Otulfi | Route-dependent |
| Mar 16, 2025 | Part B / Part D (SAD) | Injection, adalimumab, 1 mg Humira® | Excluded (all MACs) |
| Mar 16, 2025 | Part B / Part D (SAD) | Injection, adalimumab-fkjp, biosimilar, 1 mg | Excluded (all MACs) |
| Mar 16, 2025 | Part B / Part D (SAD) | Injection, adalimumab-aaty, biosimilar, 1 mg | Excluded (all MACs) |
| Mar 16, 2025 | Part B / Part D (SAD) | Injection, adalimumab-ryvk biosimilar, 1 mg | Excluded (all MACs) |
| Mar 16, 2025 | Part B / Part D (SAD) | Injection, adalimumab-adbm, biosimilar, 1 mg | Excluded (all MACs) |
| Mar 16, 2025 | Part B / Part D (SAD) | Injection, adalimumab-aacf (idacio), biosimilar, 1 mg | Excluded (all MACs) |
| Mar 16, 2025 | Part B / Part D (SAD) | Injection, adalimumab-afzb (abrilada), biosimilar, 1 mg | Excluded (all MACs) |
| Mar 16, 2025 | Part B / Part D (SAD) | Injection, ustekinumab-ttwe (pyzchiva), subcutaneous, 1 mg pyzchiva | Excluded (all MACs) |
| Mar 16, 2025 | Part B / Part D (SAD) | Injection, ustekinumab-aekn (selarsdi), 1 mg ustekinumab-aekn (selarsdi) | Route-dependent |
| Sep 1, 2024 | Part B / Part D (SAD) | Zymfentra (infliximab-dyyb) | Route-dependent |
| Jul 1, 2024 | Part B / Part D (SAD) | Omvoh mirikizumab-mrkz | Route-dependent |
| Jul 1, 2024 | Part B / Part D (SAD) | Wezlana (ustekinumab-auub) | Route-dependent |
| Oct 25, 2023 | Part B / Part D (SAD) | INJECTION, SERMORELIN ACETATE, 1 MICROGRAM Geref Diagnostic | Excluded — varies by MAC |
| Oct 1, 2023 | Part B / Part D (SAD) | Acthar® Gel | Route-dependent |
| Oct 1, 2023 | Part B / Part D (SAD) | Purified Cortrophin Gel ® | Route-dependent |
| Sep 3, 2023 | Part B / Part D (SAD) | Insulin via insulin pump (fiasp) | Excluded (all MACs) |
| Sep 3, 2023 | Part B / Part D (SAD) | Inj. Insulin (fiasp) | Route-dependent |
| Sep 3, 2023 | Part B / Part D (SAD) | Insulin via insulin pump (lyumjev) | Excluded (all MACs) |
| Sep 3, 2023 | Part B / Part D (SAD) | Inj. insulin (lyumjev) U-100 and U-200 | Route-dependent |
Showing 32 most recent changes.
How this works
Each time we refresh from CMS, we snapshot the covered-diagnosis lists (per drug) and the Self-Administered Drug exclusion lists (per MAC) and diff them against the prior snapshot. Additions, removals, count changes, and article revisions land here with the effective date — so you can see at a glance what moved between Part B and Part D, or which drug's covered diagnoses changed, without re-reading every CMS article.
Related references
Source & verification
- Source
- Snapshot diffs of CMS Medicare Coverage Database articles (covered ICD-10) and CMS Self-Administered Drug Exclusion articles. Persisted as
cms-data/coverage-changes.jsonandcms-data/sad-changes.json. - Updated
- Aug 23, 2026; refreshed quarterly.
- Not advice
- General billing reference, not legal or billing advice. Verify against the current CMS article for your MAC.