Medicare AdvantagePrior AuthMedium impact
Imfinzi (durvalumab) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has issued a revised prior authorization policy for Imfinzi (durvalumab) effective January 1, 2025, covering multiple cancer indications including biliary tract, endometrial, gastric, hepatocellular carcinoma, and various lung cancers. The policy applies to Medicare and Medicaid plans in Florida, Kentucky, and South Carolina with specific combination therapy requirements and exclusion criteria for each indication.
Action Required
By January 1, 2025: Billing teams must update prior authorization workflows for Imfinzi (durvalumab) for Humana Medicare and Medicaid members in Florida, Kentucky, and South Carolina. Verify specific combination therapy requirements and exclusion criteria for each cancer indication before submitting prior authorization requests. Ensure documentation includes diagnosis specificity (e.g., locally advanced/metastatic status, mismatch repair status for endometrial cancer) and required combination therapies. Claims without proper prior authorization will be denied.