Medicare AdvantagePrior AuthMedium impact
MA08.136g, Dostarlimab-gxly (Jemperli)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Jun 1, 2026
We identified it
Jun 19, 2026
Summary
Medical necessity criteria for Dostarlimab-gxly (Jemperli), a pharmaceutical treatment, have been updated effective June 1, 2026. This recent policy change modifies how prior authorization and coverage determinations will be made for this drug, requiring billing teams to implement new medical necessity verification procedures before claims submission.
Action Required
By May 25, 2026: Billing team must obtain and review the complete medical necessity criteria document from the provided URL. Update prior authorization workflows in billing software to require verification of medical necessity criteria before submitting Dostarlimab-gxly (J9272) claims. Coordinate with providers to ensure clinical documentation supports medical necessity per the new criteria. Update charge capture and claims submission procedures to flag J9272 claims for medical necessity verification. Train billing staff on new requirements. Failure to comply will result in claim denials for non-compliance with medical necessity criteria.