MedicaidPrior AuthMedium impact
Columvi™ (glofitamab-gxbm)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
May 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Columvi (glofitamab-gxbm), effective May 1, 2026. This policy covers the drug for relapsed/refractory diffuse large B-cell lymphoma (DLBCL, NOS) or large B-cell lymphoma (LBCL) arising from follicular lymphoma in patients who have received two or more prior lines of systemic therapy and are being treated with Columvi as monotherapy. Prior authorization is required for all Columvi claims under Ohio Medicaid.
Action Required
By April 30, 2026: Billing team must implement prior authorization workflow for Columvi (glofitamab-gxbm/J9119) claims for all Ohio Medicaid members. Actions required: (1) Update billing system to flag all J9119 claims for Ohio Medicaid requiring prior authorization submission to Humana; (2) Create prior auth template documenting member meets all three criteria: diagnosis of DLBCL, NOS or LBCL from follicular lymphoma, receipt of two or more prior systemic therapy lines, and Columvi use as monotherapy; (3) Ensure prior auth is obtained BEFORE infusion to prevent claim denials; (4) Flag for denial any claims where member has documented disease progression on prior Columvi therapy; (5) Inform providers and oncology staff of new requirement. Claims submitted without prior authorization will be denied. Reference Humana PAL system at www.humana.com/PAL for coding questions.