CommercialPrior AuthMedium impact
08.02.05c, Retifanlimab-dlwr (Zynyz®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
New medical necessity criteria have been established for Retifanlimab-dlwr (Zynyz®), a pharmacy benefit drug. This policy change affects how providers must justify the medical necessity when prescribing this medication for commercial insurance patients.
Action Required
Before July 1, 2025: Providers prescribing Retifanlimab-dlwr (Zynyz®) must review and comply with new medical necessity criteria. Update prior authorization workflows and ensure documentation meets the new requirements. Billing team should verify prior authorization requirements in system for this medication.