Medicare AdvantageCoverageMedium impact
MA08.163d, Glofitamab-gxbm (Columvi)
Independence Blue Cross·Oncology, Hematology, Pharmacy·Pharmacy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA08.163d to align glofitamab-gxbm (Columvi) coverage criteria with current FDA labeling and NCCN guidelines. The policy now includes expanded indications for high-grade B-cell lymphomas, histologic transformation of indolent lymphomas, HIV-related B-cell lymphomas, and post-transplant lymphoproliferative disorders. ICD-10 diagnosis codes have been removed from the policy as informational only; billing teams must report the most appropriate diagnosis code supporting medical necessity.
Action Required
By July 28, 2025: Billing team must update prior authorization workflows and coverage criteria in claims management system to reflect expanded indications for J9286 (glofitamab-gxbm). Providers must document which B-cell lymphoma indication (DLBCL, high-grade, histologic transformation, HIV-related, or PTLD) supports medical necessity. Claims must include the most appropriate ICD-10 diagnosis code aligned with the specific coverage criteria met. Update templates and guidelines for clinical staff to ensure proper diagnosis code selection. Verify that second-line, third-line, and relapsed/refractory disease documentation requirements are captured before claim submission. Failure to align diagnosis codes and therapy line with policy criteria will result in claim denials.