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
Medicare Advantage has updated the medical necessity criteria for Nivolumab and relatlimab-rmbw (Opdualag™) for intravenous use. The billing team should review the new criteria to ensure proper prior authorization and documentation requirements are met for these cancer immunotherapy drugs.
Action Required
By June 16, 2025: Billing team must review the updated medical necessity criteria for Nivolumab and relatlimab-rmbw (Opdualag™) at the source URL. Update prior authorization workflows and ensure providers document medical necessity according to the new criteria. Verify coverage requirements before administering these immunotherapy treatments to Medicare Advantage patients.