Medicare AdvantageCoverageMedium impact
MA08.170a, Toripalimab-tpzi (Loqtorzi™)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Aug 18, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated medical necessity criteria and coding requirements for Toripalimab-tpzi (Loqtorzi™), a cancer immunotherapy drug. This affects pharmacy billing and requires review of medical coding and coverage criteria for this specialty oncology medication.
Action Required
By August 18, 2025: Billing team and providers must review updated medical necessity criteria for Toripalimab-tpzi (Loqtorzi™) at the source URL. Update prior authorization workflows and ensure proper documentation meets new Medicare Advantage requirements. Oncology teams should verify coding requirements before submitting claims.