Monoclonal Antibodies for the Treatment of Lymphoma
Defines medical necessity, investigational uses, documentation, and coding for monoclonal antibody drugs used to treat lymphoma and related B‑cell malignancies under the medical benefit for Premera Blue Cross.
Moved Columvi, Epkinly, and Lunsumio from policy 2.03.502 to policy 5.01.650 Bispecific Antibodies.
Moved Adcetris and Polivy from policy 2.03.502 to policy 5.01.582 Antibody-Drug Conjugate.
Updated Polivy coverage criteria to include use as bridging therapy prior to planned CD19 CAR-T treatment.
Riabni (rituximab-arrx) status changed from non-preferred to preferred; Rituxan and Rituxan Hycela updated to require trial with all preferred rituximab products.
Non-formulary exception authorizations for all drugs listed in this policy may be approved up to 12 months.
Lumoxiti criteria removed due to permanent market withdrawal of the product.
Added coverage criteria for Columvi for relapsed or refractory DLBCL after two or more lines of systemic therapies.
Added coverage criteria for Epkinly for certain adults with DLBCL.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.