CommercialPrior AuthMedium impact
08.02.20a, Toripalimab-tpzi (Loqtorzi™)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Aug 18, 2025
We identified it
Jun 19, 2026
Summary
Medical necessity criteria and coding requirements have been updated for Toripalimab-tpzi (Loqtorzi™), a cancer immunotherapy drug. This affects billing and prior authorization requirements for this specialty oncology medication.
Action Required
By August 18, 2025: Billing team must review and update prior authorization procedures for Toripalimab-tpzi (Loqtorzi™). Update billing system with new medical necessity criteria requirements. Ensure providers document appropriate medical necessity criteria before prescribing. Claims may be denied without proper documentation and authorization.