Medicare AdvantageCoverageMedium impact
MA08.152d, Nivolumab and relatlimab-rmbw (Opdualag™) for intravenous use
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Jun 16, 2025
We identified it
Jun 19, 2026
Summary
MA08.152d updates medical necessity criteria for Nivolumab and relatlimab-rmbw (Opdualag™) intravenous combination therapy. This is a recent policy change (1 month old) affecting Medicare Advantage coverage determinations for this immunotherapy drug. Billing teams must verify that claims include updated medical necessity documentation per the new criteria effective 06/16/2025.
Action Required
By 06/16/2025: Billing and clinical teams must review MA08.152d medical necessity criteria for Nivolumab and relatlimab-rmbw (Opdualag™) and ensure all prior authorization submissions and claims documentation align with updated requirements. Update internal authorization checklists and provider guidance documents to reflect new criteria. Coordinate with providers and clinical staff to document medical necessity per policy MA08.152d. Claims submitted without updated medical necessity documentation will be subject to denial under Medicare Advantage plans.