CommercialCoverageMedium impact
08.02.05c, Retifanlimab-dlwr (Zynyz®)
Independence Blue Cross·Pharmacy, Oncology·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.02.05c establishes medical necessity criteria for Retifanlimab-dlwr (Zynyz®), a newly covered pharmaceutical. This is a recent policy change effective July 1, 2025. The billing team must understand and apply these medical necessity criteria to all claims for this drug to ensure coverage and avoid denials.
Action Required
By July 1, 2025: Billing team must obtain and review the complete medical necessity criteria for Retifanlimab-dlwr (Zynyz®) from policy 08.02.05c at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=07&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-02-05c. Providers must document all required medical necessity elements on claims. Update billing system to flag claims for Zynyz® for medical necessity review before submission. Communicate criteria to prescribing providers to ensure compliant prescribing. Claims submitted without documented medical necessity will be denied.