CommercialPrior AuthMedium impact
Toripalimab-tpzi (Loqtorzi)
BCBS Tennessee·TN · Oncology, Hematology·Medical Policy
Effective date
Dec 1, 2026
We identified it
Sep 10, 2026
Summary
BlueCross BlueShield of Tennessee has issued a new medical policy covering Toripalimab-tpzi (Loqtorzi), an immunotherapy drug approved for nasopharyngeal carcinoma and several other cancers. The policy establishes coverage criteria, prior authorization requirements, and continuation of therapy guidelines across seven indicated diagnoses. This policy is NOT YET EFFECTIVE and should not be implemented until December 1, 2026.
Action Required
By November 1, 2026: Billing and clinical teams must prepare for policy implementation. (1) Oncology providers should review the seven covered indications (NPC, anal carcinoma, small bowel adenocarcinoma, colorectal cancer, appendiceal neoplasms, NSCLC) and associated coverage criteria. (2) Billing team must configure prior authorization requirements in the claims system to flag Loqtorzi (HCPCS J9119 or equivalent) for all new requests. (3) Establish process to collect required documentation at time of service: MSI-H/dMMR/POLE-POLD1 tumor status documentation for colorectal, small bowel, and appendiceal cancers; EGFR/ALK mutation status for NSCLC. (4) Create system rules to enforce the exclusion: deny coverage if member has prior disease progression on PD-1/PD-L1 inhibitors. (5) Configure authorization periods: initial 6 months for all indications; continuation up to 24 months for NPC and NSCLC (13 cycles max for neoadjuvant NSCLC). (6) Update provider education materials and prior authorization request forms before 12/1/26. Failure to implement prior auth requirements will result in claim denials and appeal burden. Note: This is a BCBS Tennessee-only policy; verify applicability to your patient population.