MA08.136g, Dostarlimab-gxly (Jemperli)

By June 1, 2026: Billing team and providers must update clinical documentation and prior authorization processes to reflect the two newly covered indications (appendiceal neoplasms and non-small cell lung cancer per Micromedex). For all nine revised cancer types (ampullary adenocarcinoma, anal carcinoma, colon cancer, endometrial cancer, esophageal/esophagogastric junction cancer, gastric cancer, occult primary cancer, small bowel adenocarcinoma, and the newly added appendiceal neoplasms), verify that medical necessity criteria align with the most recent NCCN guidelines referenced in this policy update. Update billing software and prior authorization templates to reflect the new/revised NCCN guideline versions cited. Ensure all dostarlimab-gxly (J9272) claims are billed under Part B medical benefits only for Medicare Advantage members. No prior authorization workflow changes are required, but clinical teams should be trained on the expanded indications to support accurate diagnosis code reporting. Claims for non-covered indications outside this list will be denied.