CommercialCoverageMedium impact
08.02.07d, Glofitamab-gxbm (Columvi)
Independence Blue Cross·Oncology, Hematology, Pharmacy·Pharmacy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated Policy 08.02.07d to align glofitamab-gxbm (Columvi) coverage with current FDA labeling and NCCN guidelines. The policy now expands approved indications to include high-grade B-cell lymphomas, histologic transformation of indolent lymphomas, HIV-related B-cell lymphomas, and post-transplant lymphoproliferative disorders. ICD-10 diagnosis codes have been removed from the policy document; billing teams must now report the most appropriate diagnosis code supporting medical necessity criteria.
Action Required
By July 28, 2025: Billing and clinical teams must review and update coverage validation logic for HCPCS code J9286 (glofitamab-gxbm) to reflect expanded indications: (1) high-grade B-cell lymphomas, (2) histologic transformation of indolent lymphomas to DLBCL, (3) HIV-related B-cell lymphomas, and (4) post-transplant lymphoproliferative disorders. Update prior authorization templates and decision support rules to align with new NCCN-preferred sequencing (second-line with GemOx combination, third-line as monotherapy after ≥2 prior lines). Providers must document specific diagnosis and line of therapy on claims, as ICD-10 codes are no longer listed in policy. Train oncology billing staff on new eligibility criteria. Claims submitted after 07/28/2025 must meet updated medical necessity criteria or face denial. Coordinate with oncology practices to ensure documentation captures all required elements (disease type, prior therapy lines, CAR-T eligibility status where applicable).