Medicare AdvantagePrior AuthMedium impact
MA08.173a, Tislelizumab-jsgr (Tevimbra®)
Independence Blue Cross·Oncology·Pharmacy
Effective date
Jun 1, 2026
We identified it
Jun 19, 2026
Summary
MA08.173a updates medical necessity criteria for Tislelizumab-jsgr (Tevimbra®), a PD-1 inhibitor immunotherapy. This policy change affects prior authorization and coverage requirements for this pharmaceutical agent under Medicare Advantage plans effective June 1, 2026.
Action Required
By May 15, 2026: Billing team must review the complete MA08.173a policy text to identify specific medical necessity criteria changes and update prior authorization workflows. Update billing system to reflect new approval requirements for HCPCS J9173 (Tislelizumab-jsgr). Communicate updated requirements to oncology providers and clinical staff. Ensure all Tevimbra® claims submitted after June 1, 2026 comply with revised medical necessity documentation. Claims submitted without proper documentation per new criteria will be denied.