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Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™)
BCBS Tennessee·Oncology, Hematology·Medical Policy
Effective date
Dec 1, 2026
We identified it
Sep 10, 2026
Summary
This is a NEW medical policy for Opdivo Qvantig (nivolumab and hyaluronidase-nvhy), a subcutaneous formulation of nivolumab approved for multiple cancer indications. The policy establishes coverage criteria for specific FDA-approved indications and compendial uses across multiple cancer types, with requirements for prior authorization and specific documentation (MSI-H/dMMR status, EGFR/ALK mutations, PD-L1 expression, HER2 status where applicable). The policy becomes effective December 1, 2026, but is flagged as 'Do Not Implement' until that date.
Action Required
DEADLINE: Before December 1, 2026 - Billing and clinical teams must: (1) Update billing system to recognize Opdivo Qvantig (nivolumab and hyaluronidase-nvhy) as a covered medication for the specified cancer indications; (2) Establish prior authorization workflow requiring submission of: laboratory reports confirming MSI-H/dMMR/POLE/POLD1 status (where applicable), documentation of absence of EGFR exon 19 deletion, exon 21 L858R mutations, ALK, RET, and ROS1 fusions (where applicable), PD-L1 expression status (where applicable), and HER2 status (where applicable); (3) Train providers to include required documentation with all Opdivo Qvantig requests; (4) Update encounter templates and clinical documentation requirements to capture necessary tumor marker and mutation data; (5) Configure system to deny or flag claims for patients with prior PD-1/PD-L1 inhibitor progression without documented exceptions. NOTE: Policy is approved but implementation is prohibited until 12/1/26 - do not process claims under this policy before effective date. After effective date, claims lacking required prior authorization and supporting documentation will be denied.