Medicare AdvantagePrior AuthHigh impact
Atezolizumab products (Tecentriq, Tecentriq Hybreza) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jul 21, 2026
Summary
Humana revised its Atezolizumab (Tecentriq, Tecentriq Hybreza) pharmacy coverage policy effective January 1, 2025, with a revision date of July 22, 2026. This prior authorization policy covers eight cancer indications (advanced/metastatic NSCLC, bladder cancer, subsequent NSCLC, adjuvant NSCLC, small cell lung cancer, hepatocellular carcinoma, melanoma, and alveolar soft part sarcoma) across Medicare and three state Medicaid programs. Billing teams must verify prior authorization requirements and clinical criteria before processing claims for these oncology drugs.
Action Required
Effective immediately: Billing team must implement prior authorization requirements for all Atezolizumab product claims (Tecentriq IV and Tecentriq Hybreza subcutaneous) for Medicare, Florida Medicaid, Kentucky Medicaid, and South Carolina Medicaid members. Before processing ANY claim: (1) Verify member's cancer diagnosis matches one of eight covered indications; (2) Confirm clinical criteria are met (e.g., PD-L1 testing results, EGFR/ALK status, chemotherapy history, genomic mutations); (3) Check for exclusions, particularly prior anti-PD-1/PD-L1 therapy progression; (4) Obtain prior authorization before claim submission; (5) Document approval duration (initial 6 months, renewal 6 months per clinical review). Update billing software and encounter templates to require these verification steps. Route all requests to the authorization department with supporting documentation. Claims submitted without prior authorization will be denied. Providers should be notified of these requirements immediately.