Medicare AdvantagePrior AuthMedium impact
Aliqopa™ (copanlisib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jul 23, 2025
We identified it
Jun 25, 2026
Summary
Humana updated its Aliqopa (copanlisib) prior authorization policy for Medicare Advantage members with relapsed follicular lymphoma. The policy requires prior authorization and establishes specific approval criteria: diagnosis of follicular lymphoma, relapsed/refractory/progressive disease, at least two prior systemic therapies, and monotherapy use only. Claims will be denied if members have experienced disease progression on prior PI3K inhibitors.
Action Required
By July 23, 2025: Billing team must implement prior authorization requirements for Aliqopa (copanlisib) intravenous solution claims for Medicare Advantage members. Update billing system to flag all copanlisib claims requiring prior auth submission. Ensure claims are submitted with documentation of: (1) follicular lymphoma diagnosis, (2) evidence of relapsed/refractory/progressive disease, (3) documentation of at least two prior systemic therapies, and (4) confirmation of monotherapy use. Providers must review the exclusion criterion: deny or refer for clinical review any claims from members with prior disease progression on PI3K inhibitors (idelalisib or copanlisib). Update prior authorization submission forms and provider alerts. Failure to obtain prior authorization will result in claim denials. Contact Humana PAL at www.humana.com/PAL for specific medical/procedural coding information and approval duration (initial 6 months, then 6-month renewals).