Medicare AdvantageCoverageMedium impact
MA08.136f, Dostarlimab-gxly (Jemperli)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
May 19, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA08.136g (effective 05/19/2025) to add anal carcinoma as a new covered indication for dostarlimab-gxly (Jemperli) and revised medical necessity criteria for six existing cancer types based on updated NCCN guidelines. All ICD-10 codes were removed from the policy as informational; billing teams must report the most appropriate diagnosis code supporting medical necessity for each case.
Action Required
By May 19, 2025: Billing and prior authorization teams must update systems and clinical workflows for dostarlimab-gxly (Jemperli) claims to reflect new anal carcinoma coverage and revised criteria for colon cancer, rectal cancer, esophageal/esophagogastric junction cancers, gastric cancer, pancreatic adenocarcinoma, small bowel adenocarcinoma, and uterine neoplasms. Providers must document patient diagnosis code with prior authorization requests for HCPCS J9272. Update EMR templates and authorization forms to reflect that anal carcinoma is now a covered indication for both single-agent dostarlimab (second-line and subsequent therapy without prior immunotherapy) and combination therapy with paclitaxel/carboplatin (inguinal node recurrence, primary metastatic treatment, or first-line with persistent/progressive locoregional disease). Medical records must demonstrate all applicable medical necessity criteria per policy. Claims submitted without proper diagnosis code documentation or failing to meet revised criteria will be denied.