CommercialDocumentationMedium impact
08.01.60g, Sacituzumab govitecan-hziy (Trodelvy™)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.01.60g updates medical necessity criteria and medical coding guidelines for Sacituzumab govitecan-hziy (Trodelvy™), an oncology medication. The billing team must review updated documentation requirements and coding instructions to ensure compliant claim submissions for this drug.
Action Required
By August 28, 2025: Billing team and providers must review the full policy text at the provided URL to identify specific medical necessity criteria changes and updated coding requirements for Trodelvy™ claims. Update billing system rules and provider documentation templates accordingly to reflect any new prior authorization requirements or coding guidelines. Ensure all Trodelvy™ claims submitted after the effective date comply with the updated medical necessity criteria. Claims submitted without meeting updated requirements will be denied.