Medicare AdvantageCoverageMedium impact
MA08.127f, Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Aug 25, 2025
We identified it
Jun 19, 2026
Summary
MA08.127f updates medical necessity criteria for Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™). This is a pharmacy policy change affecting Medicare Advantage plans effective 08/25/2025. The billing team must verify coverage requirements and prior authorization rules have been updated in their systems for these immunotherapy drugs.
Action Required
By 08/25/2025: Billing and prior authorization teams must review the full policy text at the provided URL to identify updated medical necessity criteria for Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™). Update prior authorization workflows, clinical review guidelines, and pharmacy billing systems to reflect new requirements. Communicate changes to providers who prescribe these drugs and to pharmacy staff. Verify that claims submitted after 08/25/2025 are evaluated against the updated medical necessity criteria. Failure to implement updated criteria may result in claim denials or payment delays. Note: Specific billing codes and detailed criteria are not provided in the summary data—consult the full policy document for complete implementation details.