Sacituzumab Govitecan-hziy (Trodelvy®)

By September 15, 2026: Billing and clinical teams must prepare for implementation of this new coverage policy. (1) Notify oncology providers that Trodelvy® requires prior authorization for covered indications starting 9/30/26. (2) Update prior authorization submission requirements in billing software to require documentation of HER2, HR, and PD-L1 test results before claim submission. (3) Create internal documentation checklist for prior auth reviewers covering all coverage criteria for breast cancer (HR-positive vs HR-negative pathways) and urothelial carcinoma indications. (4) Train prior authorization staff on the 12-month authorization period and continuation of therapy requirements (no unacceptable toxicity or disease progression). (5) Verify that claims billing software correctly applies the dosing limit of 10mg/kg on days 1 and 8 of a 21-day cycle for all covered diagnoses. (6) Communicate with providers that off-label uses outside the listed compendial uses (breast cancer, urothelial carcinoma, bladder cancer, primary carcinoma of urethra, upper GU tract tumors, urothelial carcinoma of prostate) are considered experimental/investigational and not covered. Failure to obtain prior authorization will result in claim denials.