CommercialPrior AuthMedium impact
08.01.65e, Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®)
Independence Blue Cross·Oncology·Pharmacy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
The medical necessity criteria for Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®) have been updated for commercial insurance plans. This affects coverage requirements for these cancer immunotherapy drugs, which may impact prior authorization processes and billing procedures.
Action Required
By July 28, 2025: Billing team must review updated medical necessity criteria for Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®). Update prior authorization documentation requirements and ensure oncology providers are aware of new criteria. Access full policy details at the provided URL to identify specific documentation requirements.