Medicare AdvantageCoverageMedium impact
MA08.123f, Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®)
Independence Blue Cross·Oncology, Hematology, Pulmonology +3 more·Pharmacy
Effective date
Aug 24, 2026
We identified it
Aug 25, 2026
Summary
Independence Blue Cross updated MA08.123f to expand durvalumab (Imfinzi) and tremelimumab-actl (Imjudo) coverage criteria effective 08/24/2026. Small Bowel Adenocarcinoma was added as a new medically necessary indication, and coverage criteria were revised for six existing cancer types (Ampullary Adenocarcinoma, Esophageal/Esophagogastric, Gastric, Non-Small Cell Lung, Small Cell Lung, and Uterine Neoplasms). Treatment duration requirements for durvalumab were also formalized in Attachment A.
Action Required
By August 24, 2026: Billing team must update authorization systems and coverage rules in billing software to reflect the expanded indications and revised criteria. (1) Add Small Bowel Adenocarcinoma as a new covered indication for durvalumab and tremelimumab-actl. (2) Update authorization logic for the six revised cancer types to reflect new NCCN-aligned criteria. (3) Implement duration of treatment requirements from Attachment A for durvalumab claims. (4) Ensure claims processing reflects ECOG Performance Status requirements where specified. (5) Update prior authorization templates and provider communication materials. Providers must document medical necessity using updated criteria; claims submitted without alignment to revised criteria will be subject to denial. Contact Independence Blue Cross medical policy for detailed Attachment A requirements before implementation.