Medicare AdvantagePrior AuthMedium impact
Columvi™ (glofitamab-gxbm) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Feb 25, 2026
We identified it
Aug 12, 2026
Summary
Humana updated its Columvi™ (glofitamab-gxbm) prior authorization policy effective February 25, 2026, covering Medicare and three state Medicaid programs (Florida, Kentucky, South Carolina). The policy requires prior authorization for this bispecific antibody treatment in relapsed/refractory large B-cell lymphoma patients who have received at least two prior lines of systemic therapy and will receive Columvi as monotherapy. Key exclusion: patients with prior disease progression on Columvi are not eligible.
Action Required
By February 25, 2026: Billing and prior authorization teams must implement the following requirements: (1) Update billing system to flag all Columvi (glofitamab-gxbm) claims for PRIOR AUTHORIZATION for Medicare and Medicaid (FL, KY, SC) members; (2) Ensure prior auth verification confirms member meets ALL three approval criteria: diagnosis of DLBCL, NOS or LBCL arising from follicular lymphoma, two or more prior systemic therapy lines, and monotherapy use; (3) Screen for exclusion—deny or refer for clinical review if member has prior disease progression on Columvi; (4) Update encounter forms and EMR templates to require provider documentation of prior treatment lines and monotherapy intent; (5) Train prior authorization staff on the three mandatory criteria and one exclusion; (6) Configure system to set initial and renewal approval durations per plan year or clinical review determination. CONSEQUENCES: Claims submitted without prior authorization or missing required documentation will be denied. This policy applies only to specified states and Medicare—verify member eligibility before processing.