MedicaidPrior AuthHigh impact
Imfinzi (durvalumab) (New)
Humana·LA · Oncology, Hematology, Pulmonology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana is implementing a new prior authorization policy for Imfinzi (durvalumab), an intravenous cancer therapy. This policy establishes specific coverage criteria for multiple oncology indications including lung cancers, biliary tract cancer, endometrial cancer, and other malignancies, with 6-month approval periods.
Action Required
Before May 1, 2026: Billing team and oncology providers must implement prior authorization protocols for all Imfinzi (durvalumab) requests for Louisiana Medicaid patients. Update billing system to flag this medication for prior auth. Train clinical staff on specific diagnosis and combination therapy requirements for each covered indication. Establish workflow to verify patient meets criteria before treatment initiation to avoid claim denials.