Medicare AdvantageCoverageMedium impact
MA08.170b, Toripalimab-tpzi (Loqtorzi®)
Independence Blue Cross·Oncology·Pharmacy
Effective date
Jun 15, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated the medical necessity criteria for Toripalimab-tpzi (Loqtorzi®), a pharmacy benefit drug. This change affects coverage requirements and approval processes for this specific medication effective June 15, 2026.
Action Required
Before June 15, 2026: Billing and clinical teams must review the updated medical necessity criteria for Toripalimab-tpzi (Loqtorzi®) prescriptions. Update prior authorization processes and ensure documentation meets new requirements for Medicare Advantage patients. Verify coverage criteria in billing system to prevent claim denials.