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

For further information, please see the Injectable drugs page.

Code(s): J9301

Benefit: Medical

Notes: Treatment of chronic lymphocytic leukemia