CommercialCoverageMedium impact
08.02.20b, Toripalimab-tpzi (Loqtorzi®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Jun 15, 2026
We identified it
Jun 19, 2026
Summary
New medical necessity criteria have been established for Toripalimab-tpzi (Loqtorzi®), a pharmacy-covered medication. This policy change affects commercial insurance plans and will require compliance with updated coverage requirements.
Action Required
Before June 15, 2026: Billing team must review and implement new medical necessity criteria for Toripalimab-tpzi (Loqtorzi®) prescriptions. Update prior authorization processes and ensure providers document medical necessity according to new criteria. Claims without proper documentation may be denied.