Medicare AdvantagePrior AuthMedium impact
MA08.123e, Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage updated medical necessity criteria for Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®), which are cancer immunotherapy drugs. This change affects prior authorization requirements and coverage criteria for these expensive specialty medications.
Action Required
By July 28, 2025: Oncology teams must review updated medical necessity criteria for Durvalumab and Tremelimumab-actl prior authorizations. Update prior auth request templates to reflect new criteria. Verify current patients meet updated requirements to avoid coverage denials.