Medicare AdvantagePrior AuthMedium impact
MA08.163d, Glofitamab-gxbm (Columvi)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
Policy MA08.163d establishes medical necessity criteria for Glofitamab-gxbm (Columvi), a chimeric antigen receptor (CAR) T-cell therapy. This recent policy change updates coverage requirements and prior authorization guidelines for this specialty pharmacy drug effective July 28, 2025. Billing teams must verify all claims meet the specified medical necessity criteria before submission.
Action Required
By July 28, 2025: Billing team must update prior authorization (PA) protocols to require compliance with MA08.163d medical necessity criteria for Glofitamab-gxbm (HCPCS J9119). Verify all claims include documentation supporting medical necessity as defined in the policy before submission to Medicare Advantage plans. Contact oncology providers to ensure they understand updated criteria. Claims submitted without meeting medical necessity requirements will be denied. Reference the full policy at https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=07&FilterField2=MPSiteActivityLogYear&FilterValue2=2025 for specific clinical criteria.