Medicare AdvantagePrior AuthMedium impact
Zydelig® (idelalisib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jun 24, 2026
We identified it
Jul 2, 2026
Summary
Humana Medicare Advantage revised its prior authorization policy for Zydelig® (idelalisib) effective June 24, 2026. The policy requires prior authorization for idelalisib use in relapsed or refractory chronic lymphocytic leukemia (CLL) and explicitly excludes coverage for members who have experienced disease progression while on or following any PI3K inhibitor (including idelalisib itself or copanlisib). This represents a tightened approval criterion that may deny coverage for patients with prior PI3K inhibitor failure.
Action Required
By June 24, 2026: Billing and prior authorization teams must update workflows to reflect the new exclusion criterion. Specifically: (1) Before submitting prior authorization requests for Zydelig to Humana Medicare Advantage plans, verify in the member's treatment history whether they have experienced disease progression on ANY PI3K inhibitor (idelalisib, copanlisib, or others); (2) If prior PI3K inhibitor failure is documented, flag the claim as non-approvable and counsel the provider that coverage will be denied under Exclusion #1; (3) Update prior authorization templates and decision trees in billing software to require this screening question; (4) Train prior authorization specialists and billing staff on the expanded exclusion language. Failure to identify ineligible members before submission may result in unnecessary claim denials and delayed patient treatment decisions.