MedicaidPrior AuthMedium impact
Columvi™ (glofitamab-gxbm)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
May 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Medicaid (Indiana) has established a new prior authorization policy for Columvi™ (glofitamab-gxbm) effective May 1, 2026. The drug is covered for relapsed/refractory diffuse large B-cell lymphoma (DLBCL, NOS) or large B-cell lymphoma (LBCL) arising from follicular lymphoma only after two or more prior systemic therapy lines and when used as monotherapy. Claims must meet all three approval criteria and will be denied if the member has experienced prior disease progression on this agent.
Action Required
By May 1, 2026: Billing and clinical teams must implement prior authorization process for all Columvi (glofitamab-gxbm) claims submitted to Humana Medicaid Indiana. (1) Update billing system to require prior auth submission before claims processing for this drug. (2) Create or update authorization checklist requiring verification of: (a) DLBCL, NOS or LBCL arising from follicular lymphoma diagnosis, (b) documentation of two or more prior systemic therapy lines, and (c) confirmation of monotherapy use. (3) Train billing staff and providers on criteria requirements. (4) Implement denial management for claims missing required documentation or not meeting medical necessity criteria. (5) Route all requests to Humana PAL (preauthorization and notification list) per provider claim codes section. Failure to obtain prior authorization will result in claim denials. This policy applies exclusively to Humana Medicaid Indiana members.