Medicare AdvantagePrior AuthHigh impact
Yervoy® (ipilimumab) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
We identified it
Jul 2, 2026
Summary
This is a revised Prior Authorization policy for Yervoy® (ipilimumab) affecting Medicare and three state Medicaid programs (Florida, Kentucky, South Carolina). The billing team must obtain prior authorization before administering this immunotherapy drug to members in these plans to avoid claim denials.
Action Required
Immediately: Billing team must implement prior authorization requirement for Yervoy® (ipilimumab) administration for all Medicare, Medicaid-Florida, Medicaid-Kentucky, and Medicaid-South Carolina members. Update billing system to flag claims for this drug requiring prior auth approval before submission. Providers must submit prior authorization requests before treatment initiation. Contact Humana at the policy URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5c6) for specific prior auth submission procedures. Claims submitted without prior authorization will be denied.