MedicaidPrior AuthMedium impact
Imjudo (tremelimumab-actl)
Humana·LA · Oncology·Medicaid
Effective date
Dec 1, 2025
We identified it
Aug 12, 2026
Summary
Humana Louisiana Medicaid has established a new prior authorization policy for Imjudo (tremelimumab-actl) effective December 1, 2025, covering two oncology indications: unresectable hepatocellular carcinoma (requires combination with Imfinzi) and metastatic NSCLC without sensitizing genomic aberrations (requires combination with Imfinzi and platinum-based chemotherapy). Claims will require prior authorization with 6-month approval duration for initial and renewal periods.
Action Required
By December 1, 2025: Billing team and oncology providers must implement prior authorization requirements for all Imjudo claims under Louisiana Medicaid. (1) Update billing system to flag all Imjudo (tremelimumab-actl) intravenous solution claims for mandatory prior authorization. (2) Ensure providers document: (a) for HCC cases - unresectable diagnosis AND concurrent Imfinzi therapy; (b) for NSCLC cases - metastatic/advanced/recurrent diagnosis AND absence of sensitizing genomic aberrations (EGFR, ALK) AND concurrent Imfinzi plus platinum-based chemotherapy. (3) Screen all prior authorization requests for exclusion criteria: deny approval if member has experienced prior disease progression on Imjudo. (4) Configure system to set initial approvals for 6 months with renewal capability. (5) Reference www.humana.com/PAL for applicable preauthorization codes. Failure to obtain prior authorization will result in claim denials under this Louisiana Medicaid policy.