Gazyva® (obinutuzumab)

Authorization forms

Traditional & Optimized (11/2018)

Medicaid (11/2018)

Medicare Part B versus Part D determination (11/2018)

No prior authorization if billed directly to Medicare Part B

No prior authorization required for:

  • Emergency room
  • Inpatient
  • Skilled nursing facility

For further information, please see the Injectable Drugs page

Code(s): J9301

Benefit: Medical

Notes: Treatment of chronic lymphocytic leukemia