Medicare AdvantagePrior AuthMedium impact
MA08.127e, Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Apr 1, 2025
We identified it
Jun 19, 2026
Summary
This is a new pharmacy policy (MA08.127e) effective April 1, 2025, covering Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™) for Medicare Advantage plans. The policy establishes coverage criteria, prior authorization requirements, and billing guidelines for these immunotherapy drugs used primarily in oncology.
Action Required
By April 1, 2025: Billing and pharmacy teams must review the full MA08.127e policy text to identify specific HCPCS codes (likely J9022 or similar for Tecentriq formulations), prior authorization requirements, and coverage criteria. Update billing software and prior auth workflows to enforce requirements for Medicare Advantage plans. Notify providers in oncology departments of new coverage guidelines. Claims submitted without proper prior authorization may be denied. Contact the policy source at https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=04&FilterField2=MPSiteActivityLogYear&FilterValue2=2025 to obtain complete policy documentation including specific codes and authorization procedures.