Medicare AdvantagePrior AuthMedium impact
Ofev® (nintedanib) (Revised)
Humana·Pulmonology, Internal Medicine, Rheumatology·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for Ofev® (nintedanib) effective January 1, 2021, with the most recent revision dated June 24, 2026. The policy covers nintedanib for chronic fibrosing interstitial lung diseases with a progressive phenotype and requires prior authorization. No substantive coverage criteria changes are indicated from the revision, but billing teams must ensure all Ofev claims include proper prior authorization and meet the documented diagnostic and progressive phenotype criteria before dispensing.
Action Required
Immediately: Billing and pharmacy teams must verify that all Ofev® (nintedanib) claims for Medicare Advantage members include prior authorization approval before processing. Confirm member documentation includes: (1) Confirmed diagnosis of chronic fibrosing interstitial lung disease via CT or lung biopsy, AND (2) Evidence of progressive phenotype (IPF diagnosis OR ≥10% FVC decline OR worsening respiratory symptoms OR increased fibrotic changes on CT). Review the June 24, 2026 revision date and update internal policy references. When printing this policy for reference, staff must access the online version at www.humana.com/PAL to confirm it remains current before utilizing it. Failure to obtain prior authorization will result in claim denials.