Tremelimumab-actl (Imjudo) (CPB 1019, reviewed 2026-04-27)
Summary
Aetna considers tremelimumab-actl (Imjudo) medically necessary for commercial medical plans when it is given with durvalumab (Imfinzi) for hepatocellular carcinoma, non-small cell lung cancer, or esophageal, esophagogastric junction or gastric adenocarcinoma. For hepatocellular carcinoma, a one-time single dose is covered for first-line treatment when the disease is unresectable or extrahepatic/metastatic and the member is ineligible for transplant, or for subsequent treatment when the disease is unresectable or extrahepatic/metastatic and the member has not previously been treated with an anti-CTLA4-based regimen. For non-small cell lung cancer, a total of 5 doses is covered with platinum-based chemotherapy when the tumor is negative for EGFR exon 19 deletion and exon 21 L858R mutations and for ALK, RET and ROS1 rearrangements, and for esophageal, esophagogastric junction or gastric adenocarcinoma, a one-time single dose is covered for neoadjuvant treatment when the tumor is MSI-H or dMMR and the member is medically fit for surgery. Precertification is required of all Aetna participating providers and members in applicable plan designs, and all other indications are considered experimental, investigational, or unproven.
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