J9829 Insurance Policy Changes

MA08.161c, Retifanlimab-dlwr (Zynyz®)

Policy MA08.161c establishes medical necessity criteria for Retifanlimab-dlwr (Zynyz®), a PD-L1 inhibitor immunotherapy. This is a new pharmacy policy for Medicare Advantage plans effective July 1, 2025. The billing team must implement prior authorization and medical necessity documentation requirements before this date to ensure claims are processed without denial.