All PlansPrior AuthHigh impact
Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza™)
BCBS Tennessee·TN · Oncology, Pulmonology, Hematology +1 more·Medical Policy
Effective date
Sep 30, 2026
We identified it
Jul 17, 2026
Summary
This is a NEW medical policy for Tecentriq Hybreza™ (atezolizumab and hyaluronidase-tqjs), an immunotherapy drug covering multiple cancer indications including NSCLC, SCLC, HCC, melanoma, and others. The policy establishes prior authorization requirements, coverage criteria, and required documentation (including PD-L1 expression testing, genetic mutation testing, and tumor profiling). All authorizations are limited to 6-month intervals. DO NOT implement until September 30, 2026.
Action Required
By September 30, 2026: Billing and authorization teams must implement prior authorization requirements for Tecentriq Hybreza in the billing system and EMR. (1) Update billing software to require prior authorization for HCPCS codes J9008 and J9173 for all covered cancer indications listed in the policy. (2) Configure system to enforce 6-month authorization limits with automatic denial of claims submitted beyond this interval. (3) Create prior authorization checklist requiring providers to submit: PD-L1 test results (where applicable), BRAF V600 mutation testing (melanoma cases), confirmation of absence of EGFR/ALK/RET/ROS1 mutations (NSCLC cases), and MSI-H/dMMR/POLE/POLD1 testing (colon cancer and small bowel adenocarcinoma cases). (4) Train billing and clinical staff on coverage criteria by indication and exclusion rule (deny coverage if patient has experienced progression on prior PD-1/PD-L1 inhibitor therapy). (5) Update encounter forms and prior auth templates to capture disease stage, prior treatment history, and genetic/tumor profiling results. (6) Establish internal monitoring for continuation-of-therapy authorizations for adjuvant HCC, NSCLC, colon cancer, and small bowel adenocarcinoma cases. Failure to obtain proper prior authorization before claim submission will result in claim denials. Begin preparation immediately to meet September 30, 2026 implementation deadline.