Medicare AdvantagePrior AuthMedium impact
MA08.161c, Retifanlimab-dlwr (Zynyz®)
Independence Blue Cross·Oncology·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage plans have updated medical necessity criteria for Retifanlimab-dlwr (Zynyz®), a cancer immunotherapy drug. This affects prior authorization requirements and coverage determinations for this specialty oncology medication.
Action Required
By July 1, 2025: Oncology billing teams must review updated medical necessity criteria for Retifanlimab-dlwr (Zynyz®) prior authorizations. Update prior auth submission processes to align with new criteria. Verify coverage requirements with Medicare Advantage plans before administering this immunotherapy to avoid claim denials.