MedicaidPrior AuthHigh impact
Atezolizumab products (Tecentriq, Tecentriq Hybreza) (Revised)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Dec 1, 2025
We identified it
Aug 12, 2026
Summary
Humana Louisiana Medicaid has revised its prior authorization policy for Tecentriq (atezolizumab) and Tecentriq Hybreza effective December 1, 2025 (revised February 1, 2026). The policy covers seven cancer indications with specific clinical criteria and genetic testing requirements. All atezolizumab prescriptions now require prior authorization with initial and renewal approvals valid for 6 months each.
Action Required
By December 1, 2025: Billing team must implement prior authorization requirements for all Tecentriq and Tecentriq Hybreza claims submitted to Humana Louisiana Medicaid. (1) Update billing system to automatically route atezolizumab claims for prior auth approval before processing. (2) Providers must submit clinical documentation with PA requests including: diagnosis confirmation, relevant genetic testing results (EGFR, ALK, PD-L1, BRAF status per indication), current treatment regimen, and disease stage/progression status. (3) Front desk and clinical staff must screen patient charts before prescription submission to verify: appropriate cancer diagnosis, required genetic/biomarker testing completion, absence of prior anti-PD-1/PD-L1 therapy progression history, and treatment combination matches policy criteria. (4) Establish 6-month approval expiration tracking for both initial and renewal authorizations to prevent claim denials from expired PAs. (5) Flag claims for manual review if member has prior PD-L1 inhibitor therapy or exceeds 1-year treatment duration for adjuvant NSCLC (exclusion criteria). Without proper prior auth submission and approval, Humana Louisiana Medicaid will deny all atezolizumab claims.