Medicare AdvantageCoverageMedium impact
MA08.173, Tislelizumab-jsgr (Tevimbra®)
Independence Blue Cross·MA · Oncology, Pharmacy·Pharmacy
Effective date
Aug 25, 2025
We identified it
Jun 19, 2026
Summary
MA08.173 is a new pharmacy policy effective 08/25/2025 establishing coverage and billing guidelines for Tislelizumab-jsgr (Tevimbra®), a PD-1 inhibitor immunotherapy. The billing team must implement this policy immediately to ensure proper claim processing and prior authorization requirements for this new drug on Medicare Advantage plans.
Action Required
By 08/25/2025: Billing team must review the full policy text at the provided URL to identify specific HCPCS J-codes for Tislelizumab-jsgr administration and any prior authorization requirements. Update billing system and pharmacy software to reflect coverage guidelines, billing codes, and authorization workflows. Coordinate with providers and pharmacy to ensure claims include required documentation per policy. Verify which patient populations and diagnoses are covered. Claims submitted without adherence to this new policy will be subject to denial.