Glofitamab-gxbm (Columvi) (CPB 1036, reviewed 2026-02-24)
Summary
Aetna considers glofitamab-gxbm (Columvi) medically necessary for commercial medical plans for B-cell lymphoma when the member is pretreated with a single dose of obinutuzumab (Gazyva) 7 days before starting glofitamab and one of the listed criteria is met. Those criteria cover subsequent therapy with GemOx for relapsed or refractory DLBCL, high grade B-cell lymphoma, HIV-related B-cell lymphoma or post-transplant lymphoproliferative disorder; a single agent after at least 2 prior lines of systemic therapy for partial response, no response, progressive, relapsed or refractory disease with specified subtypes including DLBCL, high grade B-cell lymphoma and mantle cell lymphoma; combination with polatuzumab vedotin-piiq for Burkitt lymphoma as a bridge to transplant. Aetna also considers glofitamab-gxbm medically necessary for histologic (Richter) transformation to DLBCL with the same obinutuzumab pretreatment. Aetna considers all other indications experimental, investigational, or unproven, and continuation of therapy up to a maximum of 12 cycles is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression.
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