All PlansPrior AuthHigh impact
Obinutuzumab (Gazyva®)
BCBS Tennessee·Oncology, Hematology, Rheumatology +1 more·Medical Policy
Effective date
Sep 30, 2026
We identified it
Jul 17, 2026
Summary
This is a NEW medical policy (1 day old) for Obinutuzumab (Gazyva®) that establishes coverage criteria, prior authorization requirements, and documentation standards for multiple B-cell lymphomas, chronic lymphocytic leukemia, and lupus nephritis. The policy is APPROVED but NOT YET EFFECTIVE—do not implement until September 30, 2026. Billing teams must prepare systems now to enforce prior authorization requirements and specialty prescriber restrictions when the policy becomes active.
Action Required
BEFORE SEPTEMBER 30, 2026: Billing and clinical teams must complete the following preparations: (1) Billing team: Configure billing system to require prior authorization for HCPCS code J9301 (Obinutuzumab injection) for all applicable indications listed in the policy. Set authorization durations per policy (6 months for most lymphomas, 12 months for lupus nephritis, 1 month for glofitamab pre-treatment). (2) Prior authorization department: Create authorization templates requiring documentation of: TP53-mutation status for CLL/SLL and MCL; autoantibody panel and kidney biopsy results for lupus nephritis; disease stability/improvement for continuation requests. (3) Provider relations: Notify oncologists and rheumatologists that Obinutuzumab requires prior authorization and that lupus nephritis cases MUST be prescribed by or in consultation with rheumatology, nephrology, or lupus nephritis specialists. (4) Update encounter forms and clinical notes templates to capture required clinical data for authorization. (5) System configuration: Block claims for J9301 without prior auth approval; flag off-label uses not listed in compendial indications as experimental/investigational and route to medical director review. Failure to implement prior authorization will result in claim denials after the effective date.