CommercialPrior AuthMedium impact
08.01.94d, Nivolumab and Relatlimab-rmbw (Opdualag™) for intravenous use
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Jun 16, 2025
We identified it
Jun 19, 2026
Summary
This policy establishes or updates medical necessity criteria for Nivolumab and Relatlimab-rmbw (Opdualag™), a combination immunotherapy drug for intravenous use. The billing team must review updated prior authorization and coverage requirements effective immediately to ensure compliant claims submission.
Action Required
By June 16, 2025: Billing team must review the full policy text at the provided URL to identify specific medical necessity criteria, prior authorization requirements, and any bundling rules for Opdualag™ (J3415/J7374 HCPCS codes). Update billing system templates and prior auth workflows to reflect new requirements. Providers must document medical necessity per policy criteria before claim submission. Flag all Opdualag™ claims for manual review until workflows are validated. Contact the payer directly using the policy URL if criteria are unclear. Claims submitted without meeting medical necessity criteria will be denied.