Medicare AdvantagePrior AuthMedium impact
Aliqopa™ (copanlisib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jul 22, 2026
We identified it
Jul 22, 2026
Summary
Humana Medicare Advantage revised its Aliqopa (copanlisib) prior authorization policy effective July 22, 2026. The policy maintains coverage for relapsed/refractory follicular lymphoma patients who have received at least two prior systemic therapies and are using Aliqopa as monotherapy, with approval granted for 6-month durations. Key exclusion: patients with prior PI3K inhibitor disease progression are not eligible.
Action Required
Before July 22, 2026: Billing and prior authorization teams must update internal systems and workflows to reflect the revised Aliqopa prior authorization requirements. 1) Update prior auth submission templates to capture all four approval criteria (follicular lymphoma diagnosis, relapsed/refractory/progressive disease status, at least two prior systemic therapies, monotherapy use). 2) Configure system to flag and deny requests for patients with prior PI3K inhibitor disease progression (exclusion criterion). 3) Set approval duration logic to 6 months or clinical review determination. 4) Train clinical reviewers on the monotherapy requirement—combination therapy claims will not be approved. 5) Update provider communications and billing guidance documents. Failure to properly implement these requirements will result in denial of claims that do not meet the revised criteria.