Medicare AdvantagePrior AuthMedium impact
Tibsovo® (ivosidenib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Tibsovo® (ivosidenib) prior authorization policy effective October 22, 2025. This is a pharmacy coverage policy for an IDH1 inhibitor used in treating acute myeloid leukemia (AML), myelodysplastic syndromes (MDS), and cholangiocarcinoma. The policy maintains prior authorization requirements across four disease indications with specific clinical criteria, including documented IDH1 mutation status and disease stage requirements.
Action Required
By October 22, 2025: Billing and prior authorization teams must implement the revised Tibsovo prior authorization criteria in the billing system and PA workflows. Ensure all PA requests for Tibsovo include verification of: (1) documented IDH1 mutation for all indications, (2) appropriate disease stage (relapsed/refractory AML, newly diagnosed AML with age/comorbidity limitations, relapsed/refractory MDS, or previously treated locally advanced/metastatic cholangiocarcinoma), and (3) documented therapy plan (monotherapy vs. combination therapy per indication). Update PA templates and provider communication materials with the revised criteria. Flag any claims for Tibsovo lacking IDH1 mutation documentation or showing disease progression while on therapy (automatic exclusion). Training should emphasize the distinction between relapsed/refractory AML approval vs. newly diagnosed AML approval pathways, as they have different requirements. Failure to require proper prior authorization documentation will result in claim denials for Humana Medicare Advantage members.