CommercialAdministrativeLow impact
08.01.94d, Nivolumab and Relatlimab-rmbw (Opdualag™) for intravenous use
Independence Blue Cross·PA · Oncology, Dermatology, Pharmacy·Pharmacy
Effective date
Jun 16, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued Policy 08.01.94d for Opdualag (nivolumab and relatlimab-rmbw) with no substantive changes to coverage criteria. The policy was updated to align with NCCN Melanoma guidelines (V2.2025) and removes ICD-10 codes from the policy document itself, requiring billing teams to report appropriate diagnosis codes separately based on the stated medical necessity criteria.
Action Required
No immediate billing changes required. This is a reissue with no substantive coverage changes. Billing team should: (1) Verify that J9298 claims for Opdualag continue to be processed under existing approval criteria for unresectable/metastatic melanoma (first-line, second-line, re-induction therapy) and resectable melanoma (neoadjuvant therapy); (2) Ensure diagnosis codes submitted with J9298 claims align with the medical necessity criteria stated in the policy (cutaneous melanoma with appropriate stage/status); (3) For Pennsylvania commercial members with Stage 4 metastatic melanoma, continue to cross-reference Policy 08.01.08 for additional coverage mandates per Act 6 of 2020; (4) Document that ICD-10 codes are no longer listed in the policy—submit the most appropriate diagnosis code supporting medical necessity with each claim. No prior authorization process changes indicated.