Medicare AdvantagePrior AuthMedium impact
MA08.123e, Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
MA08.123e updates medical necessity criteria for Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®). This is a pharmacy policy affecting coverage and prior authorization requirements for these immunotherapy drugs on Medicare Advantage plans. The billing team must review updated medical necessity documentation requirements and implement any new prior authorization processes.
Action Required
By July 28, 2025: Billing team and providers must review the full policy text at the source URL to identify specific medical necessity criteria updates. Update prior authorization submission requirements in billing software if criteria have changed. Educate oncology providers on new documentation requirements for Durvalumab and Tremelimumab-actl claims. Implement any new prior auth workflows required by MA plans. Claims submitted without meeting updated medical necessity criteria will be denied.