CommercialDocumentationHigh impact
08.01.69g, Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Aug 24, 2026
We identified it
Aug 25, 2026
Summary
Policy 08.01.69g establishes or updates medical necessity criteria for Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™). This change affects how claims for these immunotherapy drugs are evaluated and approved. The billing team must implement new medical necessity requirements effective immediately.
Action Required
By 08/24/2026: Billing team and providers must immediately review and implement the updated medical necessity criteria for Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™) in policy 08.01.69g. Update clinical documentation requirements in EMR templates to capture all required medical necessity criteria. Configure billing system to flag claims for these drugs requiring manual review against new criteria before submission. Train providers and clinical staff on new documentation requirements. Communicate criteria to pharmacy staff. Without proper documentation meeting new medical necessity criteria, claims will be denied. Reference the full policy at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=08&FilterField2=MPSiteActivityLogYear&FilterValue2=2026#commercial-08-01-69g for complete criteria details.