CommercialPrior AuthHigh impact
Atezolizumab (Tecentriq) and Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza) (CPB 0909, reviewed 2026-06-30)
Aetna·Oncology, Pulmonology, Gastroenterology +1 more·Medical Policy
Effective date
Jun 30, 2026
We identified it
Aug 12, 2026
Summary
Aetna updated its clinical policy for atezolizumab (Tecentriq) and atezolizumab and hyaluronidase-tqjs (Tecentriq Hybreza) effective June 30, 2026. The policy clarifies covered indications across multiple cancer types (NSCLC, SCLC, HCC, melanoma, mesothelioma, ASPS, cervical cancer, colon cancer, thymic carcinoma, CLL, and small bowel adenocarcinoma), requires precertification for all uses, and excludes members who have progressed on prior PD-1/PD-L1 inhibitor therapy. Billing teams must implement precertification requirements and verify genetic/biomarker testing before claim submission.
Action Required
By June 30, 2026: Billing and precertification teams must implement mandatory precertification requirements for all atezolizumab (Tecentriq) and atezolizumab and hyaluronidase-tqjs (Tecentriq Hybreza) claims for Aetna commercial members. Action items: (1) Update billing system to flag all claims for these medications as requiring prior authorization before submission; (2) Create precertification checklists requiring providers to document: indication, biomarker/genetic testing results (EGFR, ALK, RET, ROS1 status for NSCLC; PD-L1 status for adjuvant NSCLC/HCC; dMMR/MSI-H or POLE/POLD1 status for colon cancer and small bowel adenocarcinoma), prior PD-1/PD-L1 inhibitor exposure, and specific treatment regimen; (3) Ensure precertification contact information is updated: phone (866) 752-7021 or fax (888) 267-3277; (4) Train providers and billing staff on exclusion criteria (disease progression on prior PD-1 or PD-L1 inhibitors = ineligible); (5) Implement site-of-care utilization management per Aetna's specialty drug infusion policy. Failure to obtain precertification will result in claim denials. Oncology providers should be notified of the specific biomarker requirements and continuation therapy limits (12 months for adjuvant HCC/NSCLC/colon cancer/small bowel adenocarcinoma; 24 months for thymic carcinoma).