Medicare AdvantagePrior AuthMedium impact
Copiktra™ (duvelisib) (Revised)
Humana·Oncology, Hematology, Pharmacy·Medicare Advantage
Effective date
Dec 17, 2025
We identified it
Aug 12, 2026
Summary
Humana updated its Copiktra (duvelisib) prior authorization policy for Medicare Advantage members with a revision effective December 17, 2025. The policy maintains three approval criteria for relapsed/refractory CLL/SLL treatment as monotherapy and includes a critical exclusion: members with prior disease progression on any PI3K inhibitor (idelalisib, copanlisib, or duvelisib) are ineligible. The policy emphasizes black box warnings for treatment-related mortality, infections, diarrhea/colitis, cutaneous reactions, and pneumonitis.
Action Required
By December 17, 2025: Billing and prior authorization teams must update pharmacy benefit system rules to reflect the revised Copiktra policy. Specifically: (1) Verify all incoming prior authorization requests for Copiktra document CLL/SLL diagnosis AND relapsed/refractory disease status AND monotherapy use; (2) Screen all requests for the PI3K inhibitor exclusion—DENY coverage if member has prior disease progression on idelalisib, copanlisib, or duvelisib; (3) Update clinical criteria template in PA system to include this exclusion language; (4) Communicate to prescribers via website or bulletin that prior PI3K inhibitor failure is now a documented barrier to coverage. Claims submitted without meeting all three approval criteria or with documented PI3K inhibitor progression history will be denied. Reference updated policy document dated 12/17/2025 when adjudicating.