Medicare AdvantageCoverageMedium impact
MA08.120g, Nivolumab (Opdivo®), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Mar 23, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.120g for Nivolumab (Opdivo®) and Nivolumab/Hyaluronidase-nvhy (Opdivo Qvantig™) has been updated with changes to medical necessity criteria and general guidelines. This affects oncology practices billing for these cancer immunotherapy drugs under Medicare Advantage plans.
Action Required
Before March 23, 2026: Oncology billing teams must review updated medical necessity criteria for Nivolumab (Opdivo®) and Nivolumab/Hyaluronidase-nvhy (Opdivo Qvantig™) at the source URL. Update prior authorization workflows and documentation requirements for Medicare Advantage patients receiving these immunotherapy treatments. Ensure clinical staff are aware of any new coverage criteria to prevent claim denials.