Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
HumanaMedicare Advantage · Prior Auth · Medicaid · FL, KY, SC · OncologyMedium impact

Imjudo (tremelimumab-actl) (Revised)

Act
by Jan 1, 2025
Effective date
Jan 1, 2025
Identified
Sep 23, 2026

Summary

Humana updated its prior authorization policy for Imjudo (tremelimumab-actl), an immunotherapy drug for treating unresectable hepatocellular carcinoma and metastatic non-small cell lung cancer. The policy requires prior authorization for both indications, with specific clinical criteria including mandatory combination therapy with Imfinzi (durvalumab) and, for NSCLC, platinum-based chemotherapy. For Medicare Part B NSCLC requests, providers must document why Libtayo (cemiplimab-rwlc) cannot be used before Imjudo approval. Coverage approval is limited to 6-month periods with clinical review renewal requirements.

Get alerts when payers change rules like this one

We check Humana and other payers every day and email you when a change matches your specialty and state.

Get Humana alertsPolicy Monitoring is free. No card required.

What to do

by Jan 1, 2025 · 7 steps
01Billing and clinical teams must implement prior authorization requirements in the billing system for all Imjudo (tremelimumab-actl) claims across Medicare, Medicaid-Florida, Medicaid-Kentucky, and Medicaid-South Carolina lines of business.
02For HCC claims, verify documentation shows unresectable diagnosis and concurrent Imfinzi administration before submission.
03For NSCLC claims, confirm: (1) metastatic/advanced/recurrent diagnosis, (2) absence of EGFR/ALK mutations, (3) concurrent Imfinzi and platinum-based chemotherapy, and (4) for Medicare Part B only, documented medical reason why Libtayo cannot be used OR is being continued from prior 365 days.
04Flag any claims showing prior disease progression on Imjudo for denial as these do not meet exclusion criteria.
05Set 6-month renewal reminders in the authorization tracking system.
06Update provider bulletins and encounter templates to alert oncologists to obtain prior authorization before administering Imjudo.
07Claims submitted without prior authorization will be denied.

Codes mentioned

J9313J9314

Original notice

Imjudo (tremelimumab-actl) (Revised)
mcp.humana.com · Always check the source before changing claims.
View original ↗

Related changes

See all Humana changes →
Rituximab products (Revised)MediumEffective Jan 1, 2026 · MedicaidImjudo (tremelimumab-actl) (Revised)HighEffective Dec 1, 2025 · MedicaidImjudo (tremelimumab-actl) (Revised)MediumEffective Dec 1, 2025 · MedicaidZynlonta™ (loncastuximab tesirine-Ipyl) (New)MediumEffective Sep 1, 2026 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesFL policy changesKY policy changesSC policy changesOncologyCode J9313Code J9314

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account