MedicaidPrior AuthMedium impact
Imfinzi (durvalumab) (New)
Humana·IN · Oncology, Hematology, Pulmonology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana is implementing a new prior authorization policy for Imfinzi (durvalumab) intravenous solution effective May 1, 2026, for Indiana Medicaid patients. The policy covers multiple cancer indications including various lung cancers, biliary tract cancer, endometrial cancer, gastric cancer, hepatocellular carcinoma, and bladder cancer, each with specific criteria and combination therapy requirements.
Action Required
Before May 1, 2026: Billing and clinical teams must implement prior authorization requirements for Imfinzi (durvalumab) for all Indiana Medicaid patients. Update authorization workflows to verify patient meets specific diagnosis criteria, required combination therapies, and exclusion criteria for each cancer indication. Ensure documentation includes disease staging, prior therapy history, and planned treatment regimens. Submit prior authorization requests with 6-month approval durations. Claims will be denied without proper prior authorization.