Medicare AdvantagePrior AuthHigh impact
Atezolizumab products (Tecentriq, Tecentriq Hybreza) (Revised)
Humana·FL, KY, SC · Oncology, Pulmonology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization requirements for atezolizumab products (Tecentriq and Tecentriq Hybreza) effective January 1, 2025, for Medicare and Medicaid plans in Florida, Kentucky, and South Carolina. The policy covers multiple oncology indications including lung cancer, hepatocellular carcinoma, melanoma, and soft part sarcoma with specific clinical criteria and exclusions.
Action Required
By January 1, 2025: Billing team must update prior authorization workflows for atezolizumab products (Tecentriq, Tecentriq Hybreza) for Humana Medicare and Medicaid plans in FL, KY, and SC. Ensure clinical documentation includes PD-L1 testing results, genomic tumor testing (EGFR/ALK), disease staging, and combination therapy details per indication-specific criteria. Verify patients have not progressed on prior anti-PD-1/PD-L1 therapy. Initial approvals limited to 6 months with required renewal documentation.