All Insurance Policy Changes (Page 14)

Continuing from page 13. 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
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.
Medium impact
Imjudo (tremelimumab-actl)
Humana·Effective Dec 1, 2025
Humana Louisiana Medicaid has established a new prior authorization policy for Imjudo (tremelimumab-actl) effective December 1, 2025, covering two oncology indications: unresectable hepatocellular carcinoma (requires combination with Imfinzi) and metastatic NSCLC without sensitizing genomic aberrations (requires combination with Imfinzi and platinum-based chemotherapy). Claims will require prior authorization with 6-month approval duration for initial and renewal periods.
Medium impact
Imjudo (tremelimumab-actl)
Humana·Effective Dec 1, 2025
Humana Medicaid (Ohio) has established a new prior authorization policy for Imjudo (tremelimumab-actl) effective December 1, 2025. The policy covers two cancer indications: unresectable hepatocellular carcinoma (must be used with Imfinzi/durvalumab) and metastatic/advanced/recurrent NSCLC without sensitizing genomic aberrations (must be used with Imfinzi and platinum-based chemotherapy). Prior authorization is required for both initial (6 months) and renewal periods, with automatic denial if the patient has experienced disease progression on Imjudo.
Medium impact
Atezolizumab products (Tecentriq, Tecentriq Hybreza) (Revised)
Humana·Effective Dec 1, 2025
Humana Indiana Medicaid has revised its prior authorization policy for Tecentriq (atezolizumab) and Tecentriq Hybreza, effective December 1, 2025. The policy covers seven cancer indications with specific clinical criteria, combination therapy requirements, and exclusions (including prior anti-PD-1/PD-L1 therapy). All atezolizumab products now require prior authorization with 6-month initial and renewal approval periods.
High impact
Atezolizumab products (Tecentriq, Tecentriq Hybreza) (Revised)
Humana·Effective Dec 1, 2025
Humana Louisiana Medicaid has revised its prior authorization policy for Tecentriq (atezolizumab) and Tecentriq Hybreza effective December 1, 2025 (revised February 1, 2026). The policy covers seven cancer indications with specific clinical criteria and genetic testing requirements. All atezolizumab prescriptions now require prior authorization with initial and renewal approvals valid for 6 months each.
High impact
Atezolizumab products (Tecentriq, Tecentriq Hybreza) (Revised)
Humana·Effective Dec 1, 2025
Humana Medicaid Ohio has issued a revised prior authorization policy for Tecentriq and Tecentriq Hybreza (atezolizumab products) effective December 1, 2025, with a revision date of February 1, 2026. This policy defines coverage criteria for seven cancer indications including NSCLC, small cell lung cancer, hepatocellular carcinoma, melanoma, and alveolar soft part sarcoma. All uses require prior authorization with specific clinical criteria and exclusions for prior anti-PD-1/PD-L1 therapy failure.
Medium impact
Asparlas™ (calaspargase pegol-mknl) (Revised)
Humana·Effective Dec 1, 2025
Humana Medicaid Indiana has issued a revised prior authorization policy for Asparlas (calaspargase pegol-mknl) effective December 1, 2025, with a revision date of July 22, 2026. The policy requires prior authorization for this intravenous chemotherapy drug used to treat acute lymphoblastic leukemia (ALL) in patients age 21 and younger as part of multi-agent chemotherapy regimens. The policy includes specific approval criteria and five clinical exclusions that may render patients ineligible for coverage.
Medium impact
Asparlas™ (calaspargase pegol-mknl) (Revised)
Humana·Effective Dec 1, 2025
Humana Louisiana Medicaid has revised its prior authorization policy for Asparlas (calaspargase pegol-mknl), a pegylated L-asparaginase used to treat acute lymphoblastic leukemia (ALL) in pediatric and young adult patients. The policy maintains strict age restrictions (≤21 years), requires use as part of multi-agent chemotherapy, and enforces five specific clinical exclusion criteria. This is a revised policy effective December 1, 2025, with the most recent update dated July 22, 2026.
Medium impact
Asparlas™ (calaspargase pegol-mknl) (Revised)
Humana·Effective Dec 1, 2025
Humana Medicaid Ohio has issued a revised prior authorization policy for Asparlas (calaspargase pegol-mknl) effective December 1, 2025, with a revision date of July 22, 2026. Prior authorization is required for this drug with strict criteria: patient must have ALL diagnosis, be age ≤21 years, and use it as part of multi-agent chemotherapy. Five specific exclusion criteria may block approval, including prior serious thrombosis, pancreatitis, hemorrhage, disease progression on Asparlas, or elevated bilirubin levels.
Medium impact
Inrebic® (fedratinib) (Revised)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage updated its prior authorization policy for Inrebic® (fedratinib) effective January 1, 2026, with a revision dated May 27, 2026. The policy requires prior authorization for this JAK2/FLT3 inhibitor used to treat intermediate-2 or high-risk myelofibrosis, with mandatory criteria including diagnosis confirmation, risk stratification, monotherapy use, and documented medical reason for not using Jakafi (ruxolitinib). Critical change: All patients must have thiamine levels assessed before treatment initiation due to a black box warning for Wernicke's encephalopathy.
Medium impact
Inqovi® (decitabine and cedazuridine) (Revised)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage revised its prior authorization policy for Inqovi® (decitabine and cedazuridine) effective January 1, 2026, with a revision dated June 24, 2026. The policy establishes coverage criteria for two indications: myelodysplastic syndromes (MDS)/CMML as a single agent, and newly diagnosed acute myeloid leukemia (AML) in patients 75+ or with comorbidities precluding intensive chemotherapy when used with venetoclax. Billing teams must implement prior authorization requirements and verify member eligibility against these specific clinical criteria before claims submission.
High impact
Imbruvica® (ibrutinib) (Revised)
Humana·Effective Jan 1, 2026
Humana has issued a revised Prior Authorization policy for Imbruvica (ibrutinib) effective January 1, 2026, with updates as of April 22, 2026. The policy covers four approved indications: CLL/SLL, Waldenstrom's Macroglobulinemia, Marginal Zone Lymphoma (second-line/subsequent monotherapy only), and Chronic Graft Versus Host Disease (age 1+, after prior systemic therapy failure). All approvals require prior authorization and will be denied if the member has experienced disease progression while on or after Imbruvica. Billing teams must implement these criteria into authorization workflows immediately.
Medium impact
Folotyn® (pralatrexate)
Humana·Effective Jan 1, 2026
Humana Indiana Medicaid has implemented a new prior authorization policy for Folotyn® (pralatrexate) effective January 1, 2026. This injectable chemotherapy requires prior auth for relapsed or refractory peripheral T-cell lymphoma (PTCL) treatment, with automatic denial if the patient has experienced disease progression while on Folotyn. Billing teams must obtain prior authorization before dispensing and verify vitamin B12/folic acid supplementation documentation.
Medium impact
Folotyn® (pralatrexate)
Humana·Effective Jan 1, 2026
Humana Louisiana Medicaid has implemented a new prior authorization policy for Folotyn® (pralatrexate) effective January 1, 2026. This policy requires prior authorization for all Folotyn use in treating relapsed or refractory peripheral T-cell lymphoma (PTCL), with approval denied if the patient has experienced disease progression while on the drug. The policy mandates that patients receive folic acid and Vitamin B12 supplementation before and during treatment.
Medium impact
Folotyn® (pralatrexate)
Humana·Effective Jan 1, 2026
Humana Medicaid Ohio has established a new prior authorization policy for Folotyn® (pralatrexate) effective January 1, 2026, for treatment of relapsed or refractory peripheral T-cell lymphoma (PTCL). Prior authorization is required for all prescriptions, with a key exclusion: members who have experienced disease progression while on Folotyn will not be approved. Billing teams must implement prior authorization workflows immediately for all Folotyn/pralatrexate claims.
Medium impact
Epkinly™ (epcoritamab-bysp) (Revised)
Humana·Effective Jan 1, 2026
Humana Louisiana Medicaid has updated its prior authorization policy for Epkinly (epcoritamab-bysp), a bispecific antibody for treating relapsed/refractory B-cell lymphomas. The policy establishes separate approval criteria for DLBCL/high-grade B-cell lymphoma (requiring 2+ prior therapy lines as monotherapy) and follicular lymphoma (allowing either monotherapy with 2+ prior lines OR combination therapy with lenalidomide/rituximab after 1+ prior line). All approvals require prior authorization with initial and renewal periods of 6 months, and CNS involvement or prior disease progression on this drug class are exclusions.
Medium impact
Daurismo™ (glasdegib) (Revised)
Humana·Effective Jan 1, 2026
Humana has revised its Daurismo (glasdegib) pharmacy coverage policy for Medicare Advantage members with newly-diagnosed acute myeloid leukemia (AML). The policy requires prior authorization and specifies strict eligibility criteria: members must be age 75+ OR have comorbidities precluding intensive chemotherapy, AND must use Daurismo in combination with low-dose cytarabine. The policy excludes members who have experienced disease progression on Daurismo.
High impact
Dasatinib products (Revised)
Humana·Effective Jan 1, 2026
Humana updated its dasatinib products (Sprycel, Phyrago, generic dasatinib) prior authorization policy effective January 1, 2026, with a revision date of April 22, 2026. The policy defines coverage criteria for five indications: adult CML, adult ALL, advanced GIST, pediatric CML, and pediatric ALL. Key requirements include Philadelphia chromosome positivity for most indications, specific disease phase/progression criteria, exclusions for certain mutations (T315I/A, F317L/V/I/C, V299L), and mandatory intolerance/contraindication documentation for brand products.
Medium impact
Columvi™ (glofitamab-gxbm) (Revised)
Humana·Effective Jan 1, 2026
Humana Louisiana Medicaid has updated its prior authorization policy for Columvi (glofitamab-gxbm), a bispecific antibody for relapsed/refractory large B-cell lymphoma. The policy requires prior auth confirmation that patients have received 2+ prior systemic therapy lines, meet specific diagnosis criteria (DLBCL, NOS or LBCL from follicular lymphoma), and will receive Columvi as monotherapy. Patients with prior disease progression on this drug are excluded.
High impact
Besponsa™ (inotuzumab ozogamicin)
Humana·Effective Jan 1, 2026
Humana Indiana Medicaid has implemented a new prior authorization policy for Besponsa (inotuzumab ozogamicin) effective January 1, 2026. The drug is now restricted to adult and pediatric patients (1+ years) with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL) who have documented CD22 blasts and are receiving Besponsa as monotherapy. Prior authorization is required with an initial approval duration of 6 months (maximum 6 cycles) and renewal for an additional 6 months (maximum 6 cycles).

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Archive by year

2023 2024 2025 2026

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)

Imjudo (tremelimumab-actl)

Imjudo (tremelimumab-actl)

Atezolizumab products (Tecentriq, Tecentriq Hybreza) (Revised)

Atezolizumab products (Tecentriq, Tecentriq Hybreza) (Revised)

Atezolizumab products (Tecentriq, Tecentriq Hybreza) (Revised)

Asparlas™ (calaspargase pegol-mknl) (Revised)

Asparlas™ (calaspargase pegol-mknl) (Revised)

Asparlas™ (calaspargase pegol-mknl) (Revised)

Inrebic® (fedratinib) (Revised)

Inqovi® (decitabine and cedazuridine) (Revised)

Imbruvica® (ibrutinib) (Revised)

Folotyn® (pralatrexate)

Folotyn® (pralatrexate)

Folotyn® (pralatrexate)

Epkinly™ (epcoritamab-bysp) (Revised)

Daurismo™ (glasdegib) (Revised)

Dasatinib products (Revised)

Columvi™ (glofitamab-gxbm) (Revised)

Besponsa™ (inotuzumab ozogamicin)