All Insurance Policy Changes (Page 179)

Continuing from page 178. 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
Vonjo® (pacritinib) (Revised)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage revised its prior authorization policy for Vonjo® (pacritinib) effective January 1, 2026, with updates through May 27, 2026. The policy requires prior authorization for this JAK inhibitor when used as monotherapy for intermediate or high-risk myelofibrosis patients with platelet counts below 50 × 10⁹/L. Billing teams must verify all four approval criteria are met before claim submission and deny coverage for patients with prior disease progression on the drug.
High impact
Viscosupplements (Revised)
Humana·Effective Jan 1, 2026
Humana Medicaid Ohio revised its viscosupplement coverage policy effective January 1, 2026, with a revision date of March 1, 2026. All viscosupplement intra-articular injections for knee osteoarthritis now require prior authorization and must meet stricter clinical criteria, including documented symptomatic knee OA, failure of two specific first-line products (for certain brands), and a 6-month interval between treatment cycles. This is a FRESH policy (1 day old) requiring immediate implementation.
Medium impact
Viberzi® (eluxadoline) (Revised)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage updated its Viberzi® (eluxadoline) prior authorization policy effective January 1, 2026, with a revision dated May 27, 2026. The policy requires prior authorization for Viberzi use in IBS-D patients and mandates documented failure or intolerance to at least TWO specific medications (loperamide, tricyclic antidepressants, or Xifaxan) before approval. Critical exclusions include patients without a gallbladder and those consuming more than 3 alcoholic beverages daily.
Medium impact
Verkazia® (cyclosporine) (Revised)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage has revised its prior authorization policy for Verkazia (cyclosporine) eye drops effective January 1, 2026 (revised April 22, 2026). Coverage now requires documented diagnosis of vernal keratoconjunctivitis (VKC) AND prior treatment failure/contraindication/intolerance to at least TWO specific topical agents (cromolyn, dexamethasone, prednisolone acetate, or fluorometholone) before approval. This is a Prior Authorization requirement that billing teams must enforce for all Verkazia claims.
Medium impact
Voyxact® (sibeprenlimab-szsi) subcutaneous injection (Revised)
Humana·Effective Jan 28, 2026
Humana Medicare Advantage has established a new prior authorization policy for Voyxact® (sibeprenlimab-szsi) subcutaneous injection, effective January 28, 2026, revised April 22, 2026. The policy requires prior authorization for this APRIL blocker used to treat primary IgAN (immunoglobulin A nephropathy) in patients at risk for disease progression. Billing teams must implement prior authorization screening for all Voyxact claims, verifying three criteria: confirmed IgAN biopsy diagnosis, appropriate indication for slowing kidney function decline, and baseline eGFR ≥30 mL/min/1.73 m2 prior to treatment initiation.
Medium impact
Zevalin® (ibritumomab tiuxetan) (New)
Humana·Effective Feb 1, 2026
Humana Medicaid Indiana has established a NEW prior authorization policy for Zevalin (ibritumomab tiuxetan), effective February 1, 2026. This is a radioimmunotherapy agent for non-Hodgkin's lymphoma that requires prior auth approval for coverage. The policy limits use to relapsed/refractory low-grade/follicular NHL or previously untreated follicular NHL patients who responded to first-line chemotherapy, with strict eligibility criteria and safety exclusions including bone marrow involvement and platelet/neutrophil thresholds.
Medium impact
Zepzelca (lurbinectedin) (New)
Humana·Effective Feb 1, 2026
Humana Medicaid (Indiana) has established a new prior authorization policy for Zepzelca (lurbinectedin) effective February 1, 2026. The policy covers two treatment pathways: single-agent use for metastatic SCLC with prior platinum-based chemotherapy progression, and combination therapy with atezolizumab for extensive-stage SCLC as maintenance after first-line induction. Prior authorization is required for all Zepzelca prescriptions under this plan.
Medium impact
Zepzelca (lurbinectedin) (New)
Humana·Effective Feb 1, 2026
Humana Medicaid (Ohio) has established a new prior authorization policy for Zepzelca (lurbinectedin) effective February 1, 2026. The policy covers two treatment pathways: (1) single-agent use for metastatic SCLC with prior platinum-based chemotherapy progression, and (2) combination therapy with atezolizumab for extensive-stage SCLC as maintenance therapy after first-line induction. All claims require prior authorization and will be denied if disease progression occurs on Zepzelca.
Medium impact
Zepzelca (lurbinectedin) (New)
Humana·Effective Feb 1, 2026
Humana Medicaid Louisiana has established a new prior authorization policy for Zepzelca (lurbinectedin) effective February 1, 2026. The policy covers two treatment pathways: (1) single-agent use for metastatic SCLC with prior platinum-based chemotherapy progression, and (2) combination therapy with atezolizumab for extensive-stage SCLC as maintenance after first-line induction therapy. All Zepzelca claims require prior authorization with specific clinical criteria documentation.
Medium impact
Zycubo® (copper histidinate) Powder for Injection (New)
Humana·Effective Feb 25, 2026
Humana has established a new prior authorization policy for Zycubo® (copper histidinate) Powder for Injection, effective February 25, 2026, covering treatment of genetically-confirmed Menkes disease in pediatric patients up to age 17 across Kentucky, South Carolina, and Virginia Medicaid programs. All claims require prior authorization with verification of ATP7A gene mutation confirmation and age eligibility before dispensing.
Low impact
Zokinvy ™ (lonafarnib) (New)
Humana·Effective Feb 25, 2026
Humana Medicare Advantage has established a new prior authorization policy for Zokinvy (lonafarnib), effective February 25, 2026. Coverage is limited to patients with Hutchinson-Gilford Progeria Syndrome or Progeroid Laminopathies with specific genetic mutations, and requires a minimum body surface area of 0.39 m². All Zokinvy prescriptions require prior authorization before dispensing.
Medium impact
Zilretta® (triamcinolone acetonide extended-release injectable suspension) (New)
Humana·Effective Mar 1, 2026
Humana Louisiana Medicaid has implemented a new prior authorization policy for Zilretta (triamcinolone acetonide extended-release injectable suspension), effective March 1, 2026. The policy requires prior authorization for intra-articular knee osteoarthritis injections and establishes three mandatory approval criteria: documented symptomatic knee OA, no prior Zilretta use in the same knee, and failure of two different short-acting intra-articular steroids. Billing teams must implement prior authorization workflows immediately to avoid claim denials.
Medium impact
Zilretta® (triamcinolone acetonide extended-release injectable suspension) (New)
Humana·Effective Mar 1, 2026
Humana Medicaid Ohio is implementing a new prior authorization requirement for Zilretta (triamcinolone acetonide extended-release), an intra-articular injection for knee osteoarthritis. Coverage requires documented symptomatic knee OA, no prior Zilretta use in the same knee, and failure of two different short-acting intra-articular steroids. This is a brand-new policy effective March 1, 2026.
Medium impact
Vimizim® (elosulfase alfa) (New)
Humana·Effective Mar 1, 2026
Humana has established a new prior authorization policy for Vimizim® (elosulfase alfa) effective March 1, 2026, for Ohio Medicaid members. Coverage requires a confirmed diagnosis of mucopolysaccharidosis IVA (MPS IVA; Morquio A Syndrome), with approvals granted for plan year durations on both initial and renewal requests. The policy includes a black box warning for anaphylaxis risk during infusions.
Medium impact
Vimizim® (elosulfase alfa) (New)
Humana·Effective Mar 1, 2026
Humana Indiana Medicaid has established a new prior authorization policy for Vimizim® (elosulfase alfa) effective March 1, 2026. This is a pharmacy coverage policy requiring prior authorization for this intravenous enzyme replacement therapy used to treat Mucopolysaccharidosis IVA (MPS IVA; Morquio A Syndrome). The sole approval criterion is diagnosis confirmation of MPS IVA, with initial and renewal approvals granted for plan year durations.
Medium impact
Yartemlea (narsoplimab-wuug)
Humana·Effective Mar 25, 2026
Humana has established a new prior authorization pharmacy coverage policy for Yartemlea (narsoplimab-wuug), effective March 25, 2026, covering Medicare and Medicaid members in Kentucky and South Carolina. The drug is approved only for adult and pediatric patients (age 2+) with hematopoietic stem cell transplant-associated thrombotic microangiopathy (TA-TMA), with initial and renewal approvals based on plan year duration or clinical review.
Medium impact
Yuviwel® (navepegritide) subcutaneous solution (New)
Humana·Effective Apr 22, 2026
Humana Medicare Advantage has issued a new prior authorization policy for Yuviwel® (navepegritide) effective April 22, 2026, for pediatric patients 2+ years old with genetically confirmed achondroplasia and open epiphyses. All prescriptions require provider attestation of diagnosis, imaging confirmation of open epiphyses, and specialist involvement (endocrinologist or achondroplasia specialist). This is a completely new coverage pathway requiring immediate workflow updates.
Medium impact
Zycubo® (copper histidinate) Powder for Injection (New)
Humana·Effective May 1, 2026
Humana Ohio Medicaid is implementing a new prior authorization requirement for Zycubo® (copper histidinate) Powder for Injection, effective May 1, 2026. Coverage is limited to pediatric patients (up to age 17) with genetically confirmed Menkes disease (ATP7A gene mutations). Billing teams must establish prior authorization workflows and ensure providers document genetic confirmation before claim submission.
Medium impact
Zycubo® (copper histidinate) Powder for Injection (New)
Humana·Effective May 1, 2026
Humana Medicaid Louisiana has established a new prior authorization policy for Zycubo® (copper histidinate) Powder for Injection, effective May 1, 2026. Coverage is limited to pediatric patients (up to 17 years) with genetically confirmed Menkes disease (ATP7A gene mutations). Providers must obtain prior authorization before dispensing and attest to genetic confirmation of diagnosis.
High impact
Xgeva® (denosumab) and biosimilars (New)
Humana·Effective May 1, 2026
Humana Medicaid (Ohio) establishes a new prior authorization policy for Xgeva (denosumab) and six biosimilars effective May 1, 2026. Coverage requires specific clinical criteria based on indication (hypercalcemia of malignancy, osteolytic bone metastases, multiple myeloma, or giant cell tumor of bone), with mandatory exclusion of concurrent bisphosphonate therapy. Billing teams must implement prior authorization workflows for all denosumab products under this policy.
Medium impact
Vyxeos™ (daunorubicin and cytarabine) liposome (New)
Humana·Effective May 1, 2026
Humana Medicaid Indiana has established a new prior authorization policy for Vyxeos (daunorubicin and cytarabine liposome) effective May 1, 2026. Coverage is limited to newly diagnosed therapy-related AML (t-AML) or AML with myelodysplasia-related changes (AML-MRC), with approval for up to 6 months covering a maximum of 2 induction cycles and 2 consolidation cycles. Prior authorization is required before dispensing.
Medium impact
Vyxeos™ (daunorubicin and cytarabine) liposome (New)
Humana·Effective May 1, 2026
Humana Medicaid Louisiana has established a NEW prior authorization policy (effective May 1, 2026) for Vyxeos (daunorubicin and cytarabine) liposome injection. Coverage is limited to adults with newly diagnosed therapy-related AML (t-AML) or AML with myelodysplasia-related changes (AML-MRC), and approvals are capped at 2 cycles of induction plus 2 cycles of consolidation per 6-month authorization period. Claims will be denied if the member has experienced prior disease progression on Vyxeos or conventional daunorubicin/cytarabine regimens.
Medium impact
Vyxeos™ (daunorubicin and cytarabine) liposome (New)
Humana·Effective May 1, 2026
Humana Medicaid (Ohio) has established a new prior authorization policy for Vyxeos (daunorubicin and cytarabine liposome), effective May 1, 2026. Coverage is limited to newly diagnosed therapy-related AML (t-AML) or AML with myelodysplasia-related changes (AML-MRC), with specific approval durations of up to 2 cycles of induction and 2 cycles of consolidation per 6-month period. Claims for patients with prior disease progression on Vyxeos or conventional daunorubicin/cytarabine regimens will be denied.
Medium impact
Visudyne® (verteporfin) (New)
Humana·Effective May 1, 2026
Humana Ohio Medicaid has implemented a new prior authorization policy for Visudyne® (verteporfin) effective May 1, 2026. The policy requires prior authorization for three indications: neovascular age-related macular degeneration (with prior bevacizumab therapy/contraindication/intolerance requirement), presumed ocular histoplasmosis, and pathologic myopia. Approvals are limited to plan year duration for both initial and renewal periods.
Medium impact
Visudyne® (verteporfin) (New)
Humana·Effective May 1, 2026
Humana Medicaid Indiana has established a new prior authorization policy for Visudyne (verteporfin) effective May 1, 2026. The policy covers three ophthalmic indications: neovascular age-related macular degeneration (requiring prior bevacizumab failure/contraindication/intolerance), presumed ocular histoplasmosis, and pathologic myopia. All Visudyne IV administrations now require prior authorization approval before treatment.

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Archive by year

2023 2024 2025 2026

Vonjo® (pacritinib) (Revised)

Viscosupplements (Revised)

Viberzi® (eluxadoline) (Revised)

Verkazia® (cyclosporine) (Revised)

Voyxact® (sibeprenlimab-szsi) subcutaneous injection (Revised)

Zevalin® (ibritumomab tiuxetan) (New)

Zepzelca (lurbinectedin) (New)

Zepzelca (lurbinectedin) (New)

Zepzelca (lurbinectedin) (New)

Zycubo® (copper histidinate) Powder for Injection (New)

Zokinvy ™ (lonafarnib) (New)

Zilretta® (triamcinolone acetonide extended-release injectable suspension) (New)

Zilretta® (triamcinolone acetonide extended-release injectable suspension) (New)

Vimizim® (elosulfase alfa) (New)

Vimizim® (elosulfase alfa) (New)

Yartemlea (narsoplimab-wuug)

Yuviwel® (navepegritide) subcutaneous solution (New)

Zycubo® (copper histidinate) Powder for Injection (New)

Zycubo® (copper histidinate) Powder for Injection (New)

Xgeva® (denosumab) and biosimilars (New)

Vyxeos™ (daunorubicin and cytarabine) liposome (New)

Vyxeos™ (daunorubicin and cytarabine) liposome (New)

Vyxeos™ (daunorubicin and cytarabine) liposome (New)

Visudyne® (verteporfin) (New)

Visudyne® (verteporfin) (New)