All Insurance Policy Changes (Page 12)

Continuing from page 11. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
Rylaze (asparaginase erwinia chrysanthemi (recombinant)-rywn) (Revised)
Humana·Effective Jul 22, 2026
Humana updated its Rylaze (asparaginase Erwinia chrysanthemi recombinant-rywn) prior authorization policy effective July 22, 2026, for Medicare and Medicaid members in Kentucky and South Carolina. This is a specialized oncology drug requiring prior authorization for ALL/LBL patients with documented Grade 2-4 hypersensitivity to prior asparaginase therapy. The policy maintains existing approval duration (6 months initial and renewal) and exclusion criteria for serious pancreatitis, thrombosis, hemorrhagic events, or disease progression.
Medium impact
Iclusig® (ponatinib) (Revised)
Humana·Effective Jan 1, 2022
Humana Medicare Advantage has revised its prior authorization policy for Iclusig® (ponatinib) effective January 1, 2022, with the most recent revision on April 22, 2026. The policy outlines specific approval criteria for three leukemia indications: chronic phase CML (requiring resistance/intolerance to two TKIs or T315I mutation), accelerated/blast phase CML, and Philadelphia chromosome positive acute lymphoblastic leukemia. Claims will be denied if the member has experienced disease progression while on Iclusig, and billing teams must verify all prior authorization requirements are met before claim submission to avoid denials.
Medium impact
Bosulif® (bosutinib) (Revised)
Humana·Effective Jan 1, 2022
This is a revised Humana Medicare Advantage prior authorization policy for Bosulif (bosutinib) effective January 1, 2022, with the most recent revision dated April 22, 2026. The policy defines coverage criteria for CML treatment, requiring prior authorization and establishing specific approval/denial criteria based on disease phase, treatment history, and genetic mutations. Billing teams must verify all Bosulif claims meet the documented clinical criteria before submission to avoid denials.
Medium impact
Besremi (ropeginterferon alfa-2b-njft) (Revised)
Humana·Effective Nov 26, 2025
Humana has revised its Besremi (ropeginterferon alfa-2b-njft) prior authorization policy effective November 26, 2025. This is a pharmacy coverage policy for polycythemia vera treatment that requires prior authorization before dispensing. The policy includes one inclusion criterion (PV diagnosis) and six exclusion criteria (hepatic decompensation, severe psychiatric disorders, immunosuppressed transplant recipients, hypersensitivity, active autoimmune disease, and disease progression on Besremi). Approval is granted for the plan year duration with renewal based on clinical review.
Medium impact
Furoscix® (furosemide) (Revised)
Humana·Effective Dec 17, 2025
Humana updated its Furoscix (furosemide) prior authorization policy for Medicare Advantage plans, effective December 28, 2022, with a revision dated December 17, 2025. The policy requires prior authorization for subcutaneous Furoscix injections in patients with heart failure or chronic kidney disease who have edema and prior loop diuretic treatment. Billing teams must ensure all Furoscix claims include proper prior authorization before submission to avoid denials.
Medium impact
Istodax (romidepsin) (Revised)
Humana·Effective Jan 28, 2026
Humana has revised its prior authorization policy for Istodax (romidepsin) effective January 28, 2026 for Medicaid members in Florida, Kentucky, and South Carolina. The policy maintains coverage for cutaneous T-cell lymphoma (CTCL) treatment when used as primary biologic systemic therapy OR after at least one prior therapy, with an explicit exclusion for members experiencing disease progression on romidepsin. Billing teams must verify prior authorization is obtained before claim submission for these Medicaid populations.
Medium impact
Hypomethylating agents (azacitidine, decitabine) (Revised)
Humana·Effective Jan 1, 2023
This is a revised Humana Medicare Advantage prior authorization policy for hypomethylating agents (azacitidine/Vidaza and decitabine/Dacogen) effective January 1, 2023, with the most recent revision dated June 24, 2026. The policy maintains prior authorization requirements for three indications: Myelodysplastic Syndromes (MDS), Acute Myelogenous Leukemia (AML), and Myeloproliferative Neoplasms (myelofibrosis). Approval duration is for the initial plan year or as determined through clinical review.
Medium impact
Elzonris™ (tagraxofusp-erzs) (Revised)
Humana·Effective Jan 1, 2023
Humana revised its prior authorization policy for Elzonris™ (tagraxofusp-erzs) effective January 28, 2026, for treatment of blastic plasmacytoid dendritic cell neoplasm (BPDCN) across Medicare and three Medicaid programs (Florida, Kentucky, South Carolina). The policy maintains three coverage criteria: confirmed BPDCN diagnosis per WHO classification, inpatient capability for the first complete course plus 24-hour observation, and patient age 2 years or older. Prior authorization is required with initial and renewal approvals valid for 6 months.
High impact
Brukinsa™ (zanubrutinib) (Revised)
Humana·Effective Apr 22, 2026
Humana Medicare Advantage has updated its Brukinsa (zanubrutinib) prior authorization policy effective April 22, 2026. The policy now covers five hematologic malignancies with specific criteria: mantle cell lymphoma (requires prior therapy and monotherapy use), CLL/SLL (diagnosis-based), marginal zone lymphoma (requires second-line use, prior anti-CD20 therapy, and monotherapy), Waldenström's macroglobulinemia (monotherapy only), and follicular lymphoma (requires 2+ prior lines and combination with obinutuzumab). All indications exclude patients with disease progression on or after Brukinsa. Billing teams must ensure prior authorization is obtained before claims submission for any of these conditions.
High impact
Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta) (Revised)
Humana·Effective Jan 1, 2023
This is a revised Humana prior authorization policy for bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta) effective January 1, 2023, with the most recent revision dated February 25, 2026. The policy establishes specific clinical criteria for coverage across five hematologic malignancies (CLL, Multiple Myeloma, Hodgkin Lymphoma, Non-Hodgkin's Lymphoma, and Waldenström's Macroglobulinemia), with a universal exclusion: members experiencing disease progression on bendamustine-containing regimens are not eligible for coverage. Prior authorization is required for all bendamustine use across Medicare Advantage, Medicare Traditional, and four state Medicaid programs.
Medium impact
Epkinly™ (epcoritamab-bysp) (Revised)
Humana·Effective Feb 25, 2026
Humana revised its prior authorization policy for Epkinly (epcoritamab-bysp) effective February 25, 2026, covering treatment of relapsed/refractory DLBCL, high-grade B-cell lymphoma, and follicular lymphoma across Medicare and three state Medicaid programs (Florida, Kentucky, South Carolina). The policy maintains prior authorization requirements with specific clinical criteria for approval, including prior therapy thresholds and monotherapy/combination therapy options.
Medium impact
Columvi™ (glofitamab-gxbm) (Revised)
Humana·Effective Feb 25, 2026
Humana updated its Columvi™ (glofitamab-gxbm) prior authorization policy effective February 25, 2026, covering Medicare and three state Medicaid programs (Florida, Kentucky, South Carolina). The policy requires prior authorization for this bispecific antibody treatment in relapsed/refractory large B-cell lymphoma patients who have received at least two prior lines of systemic therapy and will receive Columvi as monotherapy. Key exclusion: patients with prior disease progression on Columvi are not eligible.
Medium impact
Imjudo (tremelimumab-actl) (Revised)
Humana·Effective Jan 1, 2025
Humana revised its prior authorization policy for Imjudo (tremelimumab-actl) effective January 1, 2025, with a revision date of October 22, 2025. The policy covers two oncology indications: unresectable hepatocellular carcinoma (in combination with Imfinzi) and metastatic NSCLC without sensitizing genomic aberrations (in triple combination with Imfinzi and platinum-based chemotherapy). Prior authorization is required for all uses, with a key exclusion for members with prior disease progression on Imjudo.
High impact
Imfinzi (durvalumab) (Revised)
Humana·Effective Jan 1, 2025
Humana revised its Imfinzi (durvalumab) pharmacy coverage policy effective January 1, 2025, with updates through July 22, 2026. The policy establishes prior authorization requirements for Imfinzi across nine cancer indications (biliary tract, endometrial, gastric/GE junction, hepatocellular, metastatic NSCLC, perioperative NSCLC, unresectable NSCLC, small cell lung cancer, and limited-stage small cell lung cancer) with specific approval criteria, exclusions, and 6-month renewal cycles across Medicare, Florida Medicaid, Kentucky Medicaid, and South Carolina Medicaid.
High impact
Imatinib products (Gleevec, Imkeldi) (Revised)
Humana·Effective Jan 1, 2025
Humana Medicare Advantage updated its prior authorization policy for imatinib products (Gleevec, Imkeldi) effective January 1, 2025, with a revision dated January 28, 2026. The policy clarifies coverage criteria for nine indications including CML, ALL, GIST, melanoma, and others, requiring prior authorization for all uses. A critical exclusion applies across all indications: members who have experienced disease progression while on imatinib are not eligible for coverage.
High impact
Atezolizumab products (Tecentriq, Tecentriq Hybreza) (Revised)
Humana·Effective Jan 1, 2025
Humana has revised its Atezolizumab (Tecentriq, Tecentriq Hybreza) pharmacy coverage policy effective January 1, 2025, expanding the line of business to include Medicare, Medicaid-Florida, Medicaid-Kentucky, and Medicaid-South Carolina. The policy maintains prior authorization requirements across eight cancer indications with specific clinical criteria, including new genomic testing requirements, combination therapy specifications, and treatment duration limitations. Billing teams must verify member eligibility by plan type and state, ensure prior authorization is obtained before claims submission, and confirm all clinical criteria documentation is complete.
Medium impact
Blincyto® (blinatumomab) (Revised)
Humana·Effective Oct 1, 2025
This is a revised Humana Medicaid (Indiana) prior authorization policy for Blincyto® (blinatumomab), a bispecific T-cell engager for B-cell acute lymphoblastic leukemia. The policy covers three indications: relapsed/refractory B-cell ALL (with or without Philadelphia chromosome), MRD-positive B-cell precursor ALL in first/second remission, and consolidation-phase treatment. All uses require prior authorization with approval valid for the plan year or as determined through clinical review. Notable additions include explicit mention of combination therapy with tyrosine kinase inhibitors (bosutinib, dasatinib, imatinib, nilotinib, ponatinib) and specific clinical criteria referencing blast percentages and MRD thresholds.
Medium impact
Blincyto® (blinatumomab) (Revised)
Humana·Effective Oct 1, 2025
Humana Louisiana Medicaid updated its Blincyto (blinatumomab) prior authorization policy effective October 1, 2025, with a revision date of July 22, 2026. The policy establishes coverage criteria for three B-cell acute lymphoblastic leukemia (ALL) indications: relapsed/refractory ALL, MRD-positive ALL in complete remission, and consolidation-phase ALL. All uses require prior authorization with approval duration tied to plan year or clinical review. This is a comprehensive pharmacy policy with BLACK BOX WARNINGS regarding cytokine release syndrome and neurological toxicities that clinicians must monitor.
Medium impact
Blincyto® (blinatumomab) (Revised)
Humana·Effective Jul 22, 2026
Humana Medicaid Ohio updated its Blincyto (blinatumomab) pharmacy coverage policy effective July 22, 2026. The policy establishes prior authorization requirements for this bispecific T-cell engager used in B-cell acute lymphoblastic leukemia (ALL) treatment across four distinct clinical scenarios: relapsed/refractory ALL, MRD-positive ALL, and consolidation phase ALL. Billing teams must ensure all Blincyto requests include documented clinical criteria and obtain prior authorization before dispensing.
Medium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·Effective Nov 1, 2025
Humana Indiana Medicaid has issued a revised prior authorization policy for Erwinase (asparaginase Erwinia chrysanthemi) effective November 1, 2025, with a revision dated July 22, 2026. Coverage requires documentation of Grade 2-4 hypersensitivity to prior pegaspargase treatment, use in multi-agent chemotherapy for acute lymphoblastic leukemia (ALL), and exclusion of patients with serious pancreatitis, thrombosis, hemorrhage, or disease progression on prior asparaginase therapy. Initial and renewal approvals are valid for 6 months or as determined through clinical review.
Medium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·Effective Nov 1, 2025
Humana Medicaid Ohio has revised its prior authorization policy for Erwinase® (asparaginase Erwinia chrysanthemi), effective November 1, 2025. The policy requires prior authorization for this specialty oncology drug when used to treat acute lymphoblastic leukemia (ALL) in patients who have developed Grade 2-4 hypersensitivity reactions to prior E. coli-derived asparaginase (Oncaspar). Billing teams must implement prior authorization workflows and screen for four specific exclusion criteria before claims are processed.
Medium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·Effective Nov 1, 2025
Humana Louisiana Medicaid has updated its prior authorization policy for Erwinase® (asparaginase Erwinia chrysanthemi), effective November 1, 2025, with a revision dated July 22, 2026. Coverage now requires documented Grade 2-4 hypersensitivity to prior pegaspargase treatment, use as part of multi-agent chemotherapy for ALL, and excludes patients with serious pancreatitis, thrombosis, hemorrhage, or disease progression on prior asparaginase therapy. Prior authorization is required with initial and renewal approvals valid for 6 months.
Medium impact
Epkinly™ (epcoritamab-bysp) (Revised)
Humana·Effective Nov 1, 2025
Humana Medicaid Ohio has revised its prior authorization policy for Epkinly (epcoritamab-bysp), a bispecific antibody for relapsed/refractory B-cell lymphomas. The policy covers DLBCL/high-grade B-cell lymphoma after 2+ prior therapy lines (monotherapy only) and follicular lymphoma under two pathways: monotherapy after 2+ lines OR combination therapy with lenalidomide and rituximab after 1+ lines. Prior authorization is required with initial and renewal approvals valid for 6 months. Critical exclusions include active CNS involvement and prior disease progression on Epkinly or similar CD20-directed agents.
Medium impact
Epkinly™ (epcoritamab-bysp) (Revised)
Humana·Effective Nov 1, 2025
Humana Indiana Medicaid has issued a revised prior authorization policy for Epkinly (epcoritamab-bysp) effective November 1, 2025, with a revision date of May 1, 2026. The policy covers two indications: (1) DLBCL/high-grade B-cell lymphoma as monotherapy after 2+ prior lines of systemic therapy, excluding patients with CNS involvement or prior progression on Epkinly/CD20-directed CD3 engagers; and (2) Follicular lymphoma as either monotherapy after 2+ prior lines OR in combination with lenalidomide and rituximab after 1+ prior line. All approvals are issued for initial and renewal periods of 6 months or as determined through clinical review, requiring prior authorization before dispensing.
Medium impact
Imjudo (tremelimumab-actl)
Humana·Effective Dec 1, 2025
Humana Indiana Medicaid has established a new prior authorization policy (effective December 1, 2025) for Imjudo (tremelimumab-actl), an immunotherapy drug for hepatocellular carcinoma and non-small cell lung cancer. Coverage requires specific combination therapy protocols and prior authorization with 6-month approval/renewal periods. Claims for Imjudo without prior authorization or meeting clinical criteria will be denied.

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Archive by year

2023 2024 2025 2026

Rylaze (asparaginase erwinia chrysanthemi (recombinant)-rywn) (Revised)

Iclusig® (ponatinib) (Revised)

Bosulif® (bosutinib) (Revised)

Besremi (ropeginterferon alfa-2b-njft) (Revised)

Furoscix® (furosemide) (Revised)

Istodax (romidepsin) (Revised)

Hypomethylating agents (azacitidine, decitabine) (Revised)

Elzonris™ (tagraxofusp-erzs) (Revised)

Brukinsa™ (zanubrutinib) (Revised)

Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta) (Revised)

Epkinly™ (epcoritamab-bysp) (Revised)

Columvi™ (glofitamab-gxbm) (Revised)

Imjudo (tremelimumab-actl) (Revised)

Imfinzi (durvalumab) (Revised)

Imatinib products (Gleevec, Imkeldi) (Revised)

Atezolizumab products (Tecentriq, Tecentriq Hybreza) (Revised)

Blincyto® (blinatumomab) (Revised)

Blincyto® (blinatumomab) (Revised)

Blincyto® (blinatumomab) (Revised)

Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)

Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)

Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)

Epkinly™ (epcoritamab-bysp) (Revised)

Epkinly™ (epcoritamab-bysp) (Revised)

Imjudo (tremelimumab-actl)