MedicaidPrior AuthMedium impact
Nivolumab products (Opdivo, Opdivo Qvantig) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated its prior authorization policy for Nivolumab products (Opdivo and Opdivo Qvantig) effective January 1, 2025, covering multiple cancer indications including melanoma, lung cancer, kidney cancer, and others. The policy includes specific criteria for approval and exclusions for patients who have progressed on prior PD-1/PD-L1 therapies.
Action Required
Immediately: Billing team must update prior authorization requirements for Nivolumab products (Opdivo, Opdivo Qvantig) in system for Humana Medicaid patients in Florida, Kentucky, and South Carolina. Ensure documentation includes diagnosis criteria, treatment history, and exclusion criteria per the updated policy. Providers must obtain prior authorization before prescribing these medications or claims will be denied.