MedicaidPrior AuthMedium impact
Atezolizumab products (Tecentriq, Tecentriq Hybreza) (Revised)
Humana·IN · Oncology, Pulmonology·Medicaid
Effective date
Dec 1, 2025
We identified it
Aug 12, 2026
Summary
Humana Indiana Medicaid has revised its prior authorization policy for Tecentriq (atezolizumab) and Tecentriq Hybreza, effective December 1, 2025. The policy covers seven cancer indications with specific clinical criteria, combination therapy requirements, and exclusions (including prior anti-PD-1/PD-L1 therapy). All atezolizumab products now require prior authorization with 6-month initial and renewal approval periods.
Action Required
By December 1, 2025: Billing and prior authorization teams must implement the following: (1) Update billing system to flag all atezolizumab/Tecentriq claims for Humana Indiana Medicaid as requiring prior authorization; (2) Configure system to verify member meets one of seven covered indications (NSCLC advanced/metastatic frontline, NSCLC metastatic subsequent, NSCLC adjuvant, small cell lung cancer, hepatocellular carcinoma, melanoma, or alveolar soft part sarcoma); (3) Establish prior auth submission checklist requiring documentation of: diagnosis stage, PD-L1 expression levels (when applicable), FDA-approved test results, genomic mutation status (EGFR/ALK), prior cancer therapy history, and proposed treatment regimen; (4) Flag and deny claims if member has disease progression on prior anti-PD-1/PD-L1 therapy (Opdivo, Keytruda, Tecentriq, Bavencio); (5) For adjuvant NSCLC, restrict approval to maximum one year of treatment; (6) Providers and clinical staff must document all required criteria before submission. Failure to obtain prior authorization will result in claim denials. Set system reminders for 6-month renewal reviews.