Medicare AdvantagePrior AuthLow impact
Copiktra™ (duvelisib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana updated its Copiktra (duvelisib) prior authorization policy for Medicare Advantage plans, effective December 17, 2025. The policy requires prior authorization for Copiktra use in relapsed/refractory CLL/SLL patients as monotherapy, with an exclusion for patients with prior PI3K inhibitor progression. This is a routine policy revision with no substantive coverage changes from the original 2018 policy.
Action Required
By December 17, 2025: Billing team should verify that Copiktra (duvelisib) claims for Medicare Advantage members are submitted with prior authorization. Confirm that billing system reflects the three approval criteria: (1) CLL/SLL diagnosis, (2) relapsed/refractory disease status, and (3) monotherapy use. Flag any claims from patients with documented prior PI3K inhibitor progression for manual review, as these are excluded from coverage. No billing code changes required; this is a policy clarification for an existing drug already in use since 2018. Failure to obtain prior authorization may result in claim denials.