Medicare AdvantagePrior AuthMedium impact
MA08.118g, Sacituzumab govitecan-hziy (Trodelvy™)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage updated medical necessity criteria and medical coding requirements for sacituzumab govitecan-hziy (Trodelvy™), a specialty oncology medication. This affects billing and prior authorization processes for this specific cancer treatment drug.
Action Required
By July 28, 2025: Billing and clinical teams must review updated medical necessity criteria for Trodelvy™ (sacituzumab govitecan-hziy) in Medicare Advantage plans. Update prior authorization workflows and documentation requirements for this oncology medication. Verify any coding changes are implemented in billing system to ensure proper claim submission.