Aetna Updates Glofitamab-gxbm (Columvi) Coverage Policy — CPB 1036 Effective March 2026

Aetna, a CVS Health company, has modified Clinical Policy Bulletin 1036 governing coverage of glofitamab-gxbm (Columvi) for B-cell lymphoma. This update expands the covered subtypes eligible under the combination therapy pathway and adds specificity around HIV-related lymphoma diagnoses and post-transplant lymphoproliferative disorders. Billing teams managing oncology accounts need to understand the exact criteria—and the mandatory obinutuzumab pretreatment requirement—before submitting prior authorization requests.

Aetna Columvi Coverage Criteria — What CPB 1036 Actually Requires

Aetna's updated CPB 1036 covers glofitamab-gxbm (Columvi) under two distinct clinical pathways for B-cell lymphoma. Both pathways share one non-negotiable prerequisite: the member must be pretreated with a single dose of obinutuzumab (Gazyva) 7 days before initiating Columvi. Missing this step in clinical documentation will trigger a denial regardless of which pathway you're pursuing.

Pathway 1: Combination Therapy with GemOx

Columvi used in combination with GemOx (gemcitabine and oxaliplatin) is medically necessary as subsequent therapy for relapsed or refractory disease in any of the following subtypes:

Note that this pathway does not specify a minimum number of prior treatment lines. "Subsequent therapy" is the threshold, meaning the member must have received at least one prior regimen—but Aetna does not require two or more lines under this pathway.

Pathway 2: Single-Agent Monotherapy

Columvi as a single agent is medically necessary after at least 2 prior lines of systemic therapy when the member has partial response, no response, progressive, relapsed, or refractory disease. Eligible subtypes under this pathway include:

The "2 prior lines" requirement is a hard medical necessity threshold under this pathway. Your clinical documentation needs to clearly enumerate each prior line—regimen name, dates, and reason for discontinuation.

Aetna Columvi Prior Authorization Requirements

Precertification is required for all Aetna participating providers and members in applicable plan designs. There are no exceptions to this requirement under CPB 1036.

• Phone: (866) 752-7021
• Fax: (888) 267-3277
• SMN Forms: Available via Aetna's Specialty Pharmacy Precertification portal

For Medicare-covered members, CPB 1036 does not apply—Aetna directs providers to the Medicare Part B criteria separately. If your practice sees a mix of commercial and Medicare Advantage patients on Columvi, make sure your team is routing each case to the correct criteria set.

Continuation of Therapy and Reauthorization Under CPB 1036

Aetna will approve continuation of Columvi therapy up to a maximum of 12 cycles when reauthorization is requested for a covered indication and the member shows no evidence of unacceptable toxicity or disease progression on the current regimen.

This means your reauthorization workflow needs two things documented at each submission: (1) confirmation that the member's diagnosis subtype still falls within covered indications, and (2) clinical evidence of ongoing tolerability and response. A physician attestation or progress note summarizing current status should accompany every reauth request.

Affected Codes

Covered HCPCS Codes — Selection Criteria Apply

Relevant ICD-10-CM Diagnosis Codes

What Your Billing Team Should Do