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Retifanlimab-dlwr (Zynyz™)
BCBS Tennessee·TN · Oncology, Hematology·Medical Policy
Effective date
Jul 31, 2026
We identified it
Jun 17, 2026
Summary
New medical policy establishing coverage criteria for Retifanlimab-dlwr (Zynyz™), a cancer immunotherapy drug requiring prior authorization for multiple cancer types including anal canal carcinoma, Merkel cell carcinoma, and several gastrointestinal cancers. Policy requires specific laboratory documentation and excludes patients who progressed on prior PD-1/PD-L1 inhibitor therapy.
Action Required
Before July 31, 2026: Billing team must implement prior authorization requirements for Retifanlimab-dlwr (Zynyz™) for all covered cancer indications. Update system to require laboratory documentation confirming MSI-H, dMMR, or POLE/POLD1 tumor status with TMB >50 mutations/megabase where applicable. Train staff to verify patients have not progressed on prior PD-1/PD-L1 inhibitor therapy before submitting authorization requests. Claims will be denied without proper prior authorization.