CommercialPrior AuthHigh impact
Glofitamab-gxbm (Columvi) (CPB 1036, reviewed 2026-02-24)
Aetna·Hematology, Oncology·Medical Policy
Effective date
Oct 2, 2023
We identified it
Aug 15, 2026
Summary
Aetna has updated its coverage policy for glofitamab-gxbm (Columvi), a bispecific immunoglobulin monoclonal antibody for relapsed/refractory B-cell lymphomas. The policy establishes specific criteria for initial approval (combination therapy with GemOx or single-agent after 2+ prior lines) and continuation therapy (up to 12 cycles maximum). Precertification is now REQUIRED for all Aetna participating providers and members before treatment initiation.
Action Required
IMMEDIATE ACTION REQUIRED - Before billing any Columvi claims: (1) Billing team must establish precertification workflow with Aetna using phone (866) 752-7021 or fax (888) 267-3277. (2) Update billing system to REQUIRE precertification for all CPT codes 96413-96415 and HCPCS code J9286 on all Aetna commercial plans before claim submission. (3) Providers must verify member meets ONE of the two approval criteria: either combination therapy with GemOx (J9184, J9196, J9198, J9201, J9263) for relapsed/refractory disease, OR single-agent use after 2+ prior lines of systemic therapy. (4) Obtain Statement of Medical Necessity (SMN) documentation via Specialty Pharmacy Precertification portal. (5) Update encounter forms and provider alerts to document: obinutuzumab pretreatment requirement (J9301, 1,000 mg dose 7 days prior), step-up dosing schedule (2.5 mg, then 10 mg, then 30 mg), maximum 12-cycle limit, and applicable ICD-10 diagnosis codes (C83.30-C83.3A, C83.80-C83.89, C85.20-C85.29, or D47.Z1). Claims submitted without precertification will be DENIED. This policy has been effective since October 2, 2023, and applies to all current and future Columvi treatment requests.