CommercialPrior AuthMedium impact
08.01.65e, Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.01.65e updates medical necessity criteria for Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®), immunotherapy drugs used in cancer treatment. The billing team must implement new prior authorization requirements and documentation standards for these medications effective immediately.
Action Required
By 2025-07-28: Billing team must update prior authorization protocols in the billing system to require prior auth for all Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®) claims. Obtain the full policy document from the source URL to extract specific medical necessity criteria, then integrate these into the authorization process. Notify oncology providers and pharmacy staff of the new criteria. Update claim submission procedures to include documentation supporting medical necessity. Claims submitted without proper authorization or supporting documentation will be denied.