CommercialPrior AuthMedium impact
08.01.79f, Dostarlimab-gxly (Jemperli)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
May 19, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.01.79f for Dostarlimab-gxly (Jemperli) has been updated with new medical necessity criteria effective May 19, 2025. The billing team must implement these updated criteria to ensure claims meet coverage requirements and avoid denials for this pharmaceutical agent.
Action Required
By May 19, 2025: Billing team must review and implement the updated medical necessity criteria for Dostarlimab-gxly (Jemperli) HCPCS code J9272 in the billing system and prior authorization workflows. Update pharmacy benefit manager communications and prior auth submission templates to reflect the new medical necessity requirements. Providers must ensure documentation supporting medical necessity criteria is included with all claims and prior authorization requests. Claims submitted without meeting the updated medical necessity criteria will be denied.