MedicaidPrior AuthMedium impact
Columvi™ (glofitamab-gxbm) (Revised)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Louisiana Medicaid has updated its prior authorization policy for Columvi (glofitamab-gxbm), a bispecific antibody for relapsed/refractory large B-cell lymphoma. The policy requires prior auth confirmation that patients have received 2+ prior systemic therapy lines, meet specific diagnosis criteria (DLBCL, NOS or LBCL from follicular lymphoma), and will receive Columvi as monotherapy. Patients with prior disease progression on this drug are excluded.
Action Required
By January 1, 2026: Billing team and oncology providers must implement prior authorization requirements for all Columvi claims submitted to Humana Louisiana Medicaid. Verify in billing system that: (1) patient has documented diagnosis of DLBCL, NOS or LBCL arising from follicular lymphoma; (2) patient has received at least 2 prior lines of systemic therapy; (3) Columvi will be used as monotherapy (not in combination); (4) patient has no history of disease progression on prior Columvi treatment. Update encounter forms and clinical documentation templates to capture these criteria. Do not submit claims without prior authorization approval. Claims lacking prior auth or missing required clinical documentation will be denied. Reference Humana PAL portal (www.humana.com/PAL) for current medical billing codes. Policy revision date 2/25/2026 indicates active clinical oversight—contact Humana medical director for clarification on borderline cases.