Traditional MedicarePrior AuthMedium impact
Imjudo (tremelimumab-actl) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Imjudo (tremelimumab-actl) establishes specific criteria for coverage of this cancer immunotherapy drug for hepatocellular carcinoma and non-small cell lung cancer patients. The policy requires combination therapy with Imfinzi and includes step therapy requirements for Medicare Part B NSCLC requests.
Action Required
By January 1, 2025: Billing team must implement prior authorization requirements for Imjudo (tremelimumab-actl) claims. Update system to flag patients with hepatocellular carcinoma or non-small cell lung cancer who may need this drug. Ensure providers document combination therapy with Imfinzi and, for Medicare Part B NSCLC cases, medical justification if Libtayo cannot be used first. Visit www.humana.com/PAL for specific medical billing codes. Claims without proper prior authorization will be denied.