Medicare AdvantagePrior AuthMedium impact
Aliqopa™ (copanlisib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jul 22, 2026
We identified it
Aug 11, 2026
Summary
Humana updated its Aliqopa (copanlisib) prior authorization policy for Medicare Advantage members with relapsed follicular lymphoma. The policy requires prior authorization for all Aliqopa use and explicitly excludes members who have experienced disease progression on prior PI3K inhibitors. The revision date of July 22, 2026 indicates this is a very recent update requiring immediate attention.
Action Required
By July 22, 2026: Billing team must update prior authorization submission protocols for Aliqopa (copanlisib) in the billing system to reflect the revised Medicare Advantage coverage criteria. Specifically: (1) Verify all four approval criteria are documented before submitting prior auth requests: diagnosis of follicular lymphoma, relapsed/refractory/progressive disease, at least two prior systemic therapies, and monotherapy use only; (2) Add screening rule to deny or flag requests for members with prior PI3K inhibitor disease progression (idelalisib, copanlisib) - these will not be approved; (3) Update encounter templates and prior auth checklists to ensure providers document prior treatment history and confirm monotherapy use; (4) Set approval duration tracking to 6-month intervals for initial and renewal authorizations; (5) Train billing staff to reference the July 22, 2026 revision date when submitting requests and to verify this is the current policy version via Humana's online portal before each submission. Failure to obtain prior authorization or submitting with incomplete criteria documentation will result in claim denials for this high-cost specialty pharmaceutical.