It is important to establish medical necessity prior to treatment to prevent claim delays. Government and private insurers have varying criteria for determining if a treatment is medically necessary based on the patient's circumstances. Medicare uses National Coverage Determinations and private Medicare plans (i.e., Medicare Advantage) use Local Coverage Determinations in order to ensure that the criteria for medical necessity are met. Private insurers can set their own criteria, although they're required to provide coverage that's in compliance with state and federal mandates.
Prior to treatment, an office should review and document the following to determine medical necessity:
In order to determine coverage of LOQTORZI the payer needs to be contacted to complete a
benefit verification.
LOQTORZI Solutions™ may be able to assist. Enroll your patient in LOQTORZI Solutions™ and complete the benefit verification request and enroll your patient into any applicable patient support program available.
A benefit verification will:
Document medical necessity of the patient
*Refer to clinical guidelines (e.g., ASCO Guidelines, publications, etc.)
Provider offices may use the services offered by Coherus SOLUTIONSTM that include but are not limited to:
For assistance with LOQTORZI treatment approval process, call 1-844-483-3692 or visit the Coherus SolutionsTM Provider Portal.