Obinutuzumab (Gazyva) (CPB 0877, reviewed 2026-06-05)

Immediately: Billing and prior authorization teams must implement the following: (1) Update authorization request templates to require documentation of specific approved indication (CLL/SLL, follicular lymphoma, marginal zone lymphoma, mantle cell lymphoma, hairy cell leukemia, or active lupus nephritis) per CPB 0877; (2) For lupus nephritis claims, verify prescriber specialty (rheumatologist, nephrologist, or lupus nephritis specialist) and ensure documentation includes either kidney biopsy confirmation or positive SLE autoantibodies (ANA, anti-ds DNA, anti-Sm, or antiphospholipid) AND current standard therapy (cyclophosphamide, mycophenolate mofetil, azathioprine, hydroxychloroquine, or glucocorticoids); (3) Add validation rules to deny claims for experimental/investigational indications (acute lymphoblastic leukemia, Waldenstrom macroglobulinemia, rheumatoid arthritis, systemic lupus erythematosus, etc.); (4) For follicular lymphoma, enforce 30-month maximum treatment duration; (5) Configure system to require prior auth for all initial requests and continuation therapy, documenting clinical response (lupus nephritis) or absence of unacceptable toxicity/disease progression (other indications); (6) Communicate policy to all oncology and rheumatology practices. Failure to implement prior authorization controls will result in claim denials for non-approved indications.