MedicaidPrior AuthMedium impact
Imfinzi (durvalumab) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Ohio Medicaid has established a new prior authorization policy for Imfinzi (durvalumab), an IV cancer immunotherapy drug. The policy covers multiple cancer types including lung cancer, biliary tract cancer, endometrial cancer, and hepatocellular carcinoma, with specific combination therapy requirements and 6-month approval durations.
Action Required
Before May 1, 2026: Billing team must update prior authorization workflows for Imfinzi (durvalumab) infusions for Ohio Medicaid patients. Ensure providers document specific cancer diagnosis, combination therapy details, and absence of prior anti-PD-1/PD-L1 therapy progression. Submit prior authorization requests with required clinical criteria before treatment initiation. Claims will be denied without proper prior authorization.