All Insurance Policy Changes (Page 82)

Continuing from page 81. 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
Lynozyfic (linvoseltamab-gcpt) (Revised)
Humana·Effective Sep 24, 2025
Humana revised its prior authorization policy for Lynozyfic (linvoseltamab-gcpt), a bispecific antibody for relapsed/refractory multiple myeloma. The policy requires prior auth approval for Medicare and Medicaid (Kentucky and South Carolina only) members meeting strict criteria: diagnosis of multiple myeloma with relapsed/refractory disease, at least four prior lines of therapy including specific drug classes, and single-agent use only. Members with prior disease progression on BCMA-directed CD3 T-cell engagers are excluded from coverage.
Medium impact
Monjuvi® (tafasitamab-cxix) (New)
Humana·Effective Oct 1, 2025
Humana Medicaid Indiana has established a new prior authorization policy for Monjuvi® (tafasitamab-cxix), an anti-CD19 monoclonal antibody used to treat relapsed or refractory diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma. The policy requires prior authorization before dispensing and specifies strict criteria including disease type, refractoriness status, transplant ineligibility, and mandatory combination therapy protocols with maximum treatment durations.
Medium impact
Monjuvi® (tafasitamab-cxix) (New)
Humana·Effective Oct 1, 2025
Humana Medicaid Louisiana has established a new prior authorization policy for Monjuvi® (tafasitamab-cxix) effective October 1, 2025. The policy covers two indications: (1) relapsed/refractory DLBCL not eligible for stem cell transplant, used with lenalidomide for up to 12 cycles then as monotherapy; and (2) relapsed/refractory follicular lymphoma, used with lenalidomide and rituximab for maximum 12 cycles. All Monjuvi claims require prior authorization approval before dispensing.
Medium impact
Monjuvi® (tafasitamab-cxix) (New)
Humana·Effective Oct 1, 2025
This new Humana Medicaid (Ohio) policy establishes prior authorization requirements for Monjuvi® (tafasitamab-cxix) for two indications: relapsed/refractory DLBCL (not eligible for ASCT, used with lenalidomide for max 12 cycles then as monotherapy) and relapsed/refractory follicular lymphoma (used with lenalidomide and rituximab for max 12 cycles). Claims must meet specific clinical criteria and exclude patients with prior anti-CD19 therapy progression or excessive treatment duration.
Medium impact
Kalbitor (ecallantide) (New)
Humana·Effective Oct 1, 2025
Humana Indiana Medicaid has implemented a new prior authorization policy for Kalbitor (ecallantide) effective October 1, 2025, for treatment of acute hereditary angioedema (HAE) attacks. The policy requires seven specific clinical criteria be met, including HAE diagnosis confirmation, specialized lab documentation (C4, C1INH levels, C1q level), treatment by an allergy/immunology specialist, and evidence of recurrent angioedema without concomitant urticaria. All Kalbitor claims must now go through prior authorization before dispensing.
Medium impact
Elaprase® (idursulfase) (New)
Humana·Effective Oct 1, 2025
Humana Indiana Medicaid has established a new prior authorization policy for Elaprase® (idursulfase) effective October 1, 2025, for treatment of Hunter Syndrome (Mucopolysaccharidosis II). The policy requires prior authorization and approval based on confirmed Hunter Syndrome diagnosis. Billing teams must implement prior auth requirements for all Elaprase intravenous infusions for Medicaid members in Indiana.
Medium impact
Blincyto® (blinatumomab) (Revised)
Humana·Effective Oct 1, 2025
Humana has revised its Blincyto® (blinatumomab) prior authorization policy for Indiana Medicaid, effective October 1, 2025, with updates through July 22, 2026. The policy covers three treatment scenarios: relapsed/refractory B-cell ALL (as monotherapy or with tyrosine kinase inhibitors), MRD-positive B-cell precursor ALL in first/second remission, and consolidation phase treatment. All Blincyto claims require prior authorization approval before administration.
Medium impact
Blincyto® (blinatumomab) (Revised)
Humana·Effective Oct 1, 2025
This is a revised Humana Medicaid policy for Blincyto (blinatumomab) in Louisiana that establishes prior authorization requirements for three distinct indications: relapsed/refractory B-cell ALL (as monotherapy or with tyrosine kinase inhibitors), B-cell precursor ALL with MRD in first/second remission, and B-cell precursor ALL in consolidation phase. The policy includes black box warnings for cytokine release syndrome and neurological toxicities that require close patient monitoring.
Medium impact
Blincyto® (blinatumomab) (Revised)
Humana·Effective Oct 1, 2025
This is a revised Humana Medicaid (Ohio) prior authorization policy for Blincyto® (blinatumomab), a bispecific CD19-directed CD3 T-cell engager used to treat B-cell acute lymphoblastic leukemia. The policy covers three indications: relapsed/refractory B-cell ALL (as monotherapy or with tyrosine kinase inhibitors), MRD-positive B-cell precursor ALL in complete remission, and B-cell precursor ALL in consolidation phase. Prior authorization is required for all covered uses, with approval duration based on plan year or clinical review.
Medium impact
Berinert (C1 esterase inhibitor, human) (New)
Humana·Effective Oct 1, 2025
Humana Medicaid (Indiana) now requires prior authorization for Berinert (C1 esterase inhibitor, human) for hereditary angioedema (HAE) treatment. Prior authorization requires documentation of HAE diagnosis (Type 1 or 2), specific lab values (C4, C1INH levels, and C1q), specialist care, and treatment of acute attacks only. This is a new pharmacy coverage policy effective October 1, 2025.
Medium impact
Papzimeos™ (zopapogene imadenovec-drba) (Revised)
Humana·Effective Oct 22, 2025
Humana has updated its prior authorization policy for Papzimeos™ (zopapogene imadenovec-drba), an immunotherapy for recurrent respiratory papillomatosis (RRP). The policy requires prior authorization and mandates that patients meet four specific criteria: biopsy-confirmed RRP diagnosis, concurrent surgical debulking procedures, age 18+, and supporting documentation. Prior auth is denied if the patient has completed a previous treatment course.
Medium impact
Kimmtrak (tebentafusp-tebn) (New)
Humana·Effective Oct 22, 2025
Humana Medicaid (Ohio) has established a new prior authorization policy for Kimmtrak (tebentafusp-tebn), a specialized immunotherapy for HLA-A*02:01-positive patients with unresectable or metastatic uveal melanoma. Approval requires three criteria: unresectable/metastatic uveal melanoma diagnosis, documented HLA-A*02:01-positive disease by assay, and use as monotherapy. Claims will be denied without prior authorization and if the patient experiences disease progression on the drug.
Medium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·Effective Nov 1, 2025
Humana Medicaid Indiana has revised the prior authorization policy for Erwinase (asparaginase Erwinia chrysanthemi), a chemotherapy agent used to treat acute lymphoblastic leukemia (ALL) in patients who developed hypersensitivity to prior asparaginase therapy. The policy requires prior authorization with specific clinical criteria (Grade 2-4 hypersensitivity to Oncaspar documented, use in multi-agent chemotherapy) and excludes patients with serious history of pancreatitis, thrombosis, hemorrhage, or disease progression on asparaginase therapy. Approval is granted for initial and renewal periods of 6 months or as determined through clinical review.
Medium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·Effective Nov 1, 2025
Humana Medicaid (Ohio) revised its prior authorization policy for Erwinase (asparaginase Erwinia chrysanthemi) effective November 1, 2025. The policy requires prior authorization for ALL members with acute lymphoblastic leukemia (ALL) who have Grade 2-4 hypersensitivity to prior pegaspargase (Oncaspar) treatment and are using Erwinase as part of multi-agent chemotherapy. Four specific exclusions apply: history of serious pancreatitis, thrombosis, hemorrhagic events, or disease progression on asparaginase therapy. Initial and renewal approvals are limited to 6 months.
Medium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·Effective Nov 1, 2025
Humana Louisiana Medicaid updated its Erwinase (asparaginase Erwinia chrysanthemi) pharmacy coverage policy, effective November 1, 2025, with a revision date of July 22, 2026. Coverage requires prior authorization and mandates that members have documented Grade 2-4 hypersensitivity to prior Oncaspar treatment, ALL diagnosis, and use within a multi-agent chemotherapy regimen. The policy excludes members with history of serious pancreatitis, thrombosis, hemorrhagic events, or disease progression on asparaginase therapy.
Medium impact
Elrexfio (elranatamab-bcmm) (Revised)
Humana·Effective Nov 1, 2025
This is a revised Humana Medicaid (Indiana) prior authorization policy for Elrexfio (elranatamab-bcmm), a bispecific BCMA-directed CD3 T-cell engager for relapsed/refractory multiple myeloma. The policy requires prior authorization and mandates that patients meet strict criteria including relapsed/refractory disease status, at least four prior lines of therapy (including specific drug classes), and single-agent use only. Claims will be denied if patients have prior disease progression on BCMA-directed therapies.
Medium impact
Elrexfio (elranatamab-bcmm) (Revised)
Humana·Effective Nov 1, 2025
This is a revised Medicaid (Ohio) prior authorization policy for Elrexfio (elranatamab-bcmm), a bispecific BCMA-directed CD3 T-cell engager for relapsed/refractory multiple myeloma. The policy requires prior authorization and establishes four approval criteria: confirmed multiple myeloma diagnosis, relapsed/refractory disease, receipt of at least four prior therapy lines (including specific agent classes), and single-agent use. One exclusion applies: prior disease progression on a BCMA-directed bispecific regimen. The policy emphasizes black box warnings for cytokine release syndrome and neurologic toxicity, requiring step-up dosing and patient monitoring.
Medium impact
Papzimeos™ (zopapogene imadenovec-drba) (Revised)
Humana·Effective Dec 1, 2025
Humana Indiana Medicaid implemented a revised prior authorization policy for Papzimeos (zopapogene imadenovec-drba), an immunotherapy for recurrent respiratory papillomatosis (RRP). The policy requires prior authorization for this drug and mandates that members meet four specific criteria: biopsy-confirmed RRP diagnosis, concurrent surgical debulking/removal procedures, age 18+, and supporting clinical documentation. Members who have previously completed a treatment course are excluded from coverage.
Medium impact
Papzimeos™ (zopapogene imadenovec-drba) (New)
Humana·Effective Dec 1, 2025
Humana Ohio Medicaid is establishing a new prior authorization requirement for Papzimeos™ (zopapogene imadenovec-drba), an immunotherapy for recurrent respiratory papillomatosis (RRP). Billing teams must verify patients meet all four coverage criteria and have no exclusions before submitting claims. This is a brand-new policy effective December 1, 2025.
Medium impact
Kimmtrak (tebentafusp-tebn) (Revised)
Humana·Effective Dec 1, 2025
Humana Medicaid (Indiana) requires prior authorization for Kimmtrak (tebentafusp-tebn) in metastatic uveal melanoma treatment. Billing teams must verify three approval criteria before claims submission: unresectable/metastatic uveal melanoma diagnosis, HLA-A*02:01-positive disease documentation, and monotherapy use. Claims will be denied without prior authorization and documented compliance with all criteria.
Medium impact
Kimmtrak (tebentafusp-tebn) (Revised)
Humana·Effective Dec 1, 2025
Humana Medicaid Louisiana revised the Kimmtrak (tebentafusp-tebn) prior authorization policy effective December 1, 2025, with updates as of July 22, 2026. The policy requires prior authorization for this rare cancer treatment and mandates three specific approval criteria: diagnosis of unresectable/metastatic uveal melanoma, HLA-A*02:01-positive status confirmed by assay, and monotherapy use. Claims will be denied if the member has experienced disease progression while on Kimmtrak.
Low impact
Asparlas™ (calaspargase pegol-mknl) (Revised)
Humana·Effective Dec 1, 2025
This is a revised Medicaid (Indiana) 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 requires prior authorization and specifies strict age criteria (≤21 years), exclusionary conditions (prior thrombosis, pancreatitis, hemorrhagic events, disease progression on Asparlas, or severely elevated bilirubin), and initial/renewal approval durations of 6 months or as determined by clinical review.
Medium impact
Asparlas™ (calaspargase pegol-mknl) (Revised)
Humana·Effective Dec 1, 2025
Humana Medicaid Louisiana has revised its prior authorization policy for Asparlas (calaspargase pegol-mknl), a chemotherapy drug for acute lymphoblastic leukemia (ALL) in patients age ≤21 years. The policy clarifies approval criteria requiring ALL diagnosis, use in multi-agent chemotherapy regimens, and age restrictions, while identifying five specific exclusions (disease progression on Asparlas, history of serious thrombosis/pancreatitis/hemorrhage with prior asparaginase therapy, and elevated bilirubin >10x upper limit of normal). Prior authorization is required for all Asparlas claims under this plan.
Medium impact
Asparlas™ (calaspargase pegol-mknl) (Revised)
Humana·Effective Dec 1, 2025
This is a revised Humana Medicaid (Ohio) prior authorization policy for Asparlas (calaspargase pegol-mknl), effective December 1, 2025, with a revision date of July 22, 2026. The policy establishes coverage criteria for this pegylated L-asparaginase medication as part of multi-agent chemotherapy for acute lymphoblastic leukemia (ALL) in patients age ≤21 years, and identifies five exclusion criteria that may prevent approval (prior disease progression on Asparlas, history of serious thrombosis/pancreatitis/hemorrhage with asparaginase, or elevated bilirubin >10x ULN).
Medium impact
Brekiya® (dihydroergotamine mesylate) (Revised)
Humana·Effective Dec 17, 2025
Humana Medicare Advantage has implemented a revised prior authorization policy for Brekiya (dihydroergotamine mesylate) subcutaneous auto-injector, effective December 17, 2025, with a revision date of July 22, 2026. Coverage now requires prior authorization for acute migraine treatment (requires failure/intolerance of Ubrelvy AND one triptan/NSAID) and cluster headache treatment (requires failure/intolerance of at least two triptans). Billing teams must implement prior authorization screening before claims submission to prevent denials.

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2023 2024 2025 2026

Insurance Policy Changes Tracker: All Payer Updates (Page 82) | PolicyChanges.app

Lynozyfic (linvoseltamab-gcpt) (Revised)

Monjuvi® (tafasitamab-cxix) (New)

Monjuvi® (tafasitamab-cxix) (New)

Monjuvi® (tafasitamab-cxix) (New)

Kalbitor (ecallantide) (New)

Elaprase® (idursulfase) (New)

Blincyto® (blinatumomab) (Revised)

Blincyto® (blinatumomab) (Revised)

Blincyto® (blinatumomab) (Revised)

Berinert (C1 esterase inhibitor, human) (New)

Papzimeos™ (zopapogene imadenovec-drba) (Revised)

Kimmtrak (tebentafusp-tebn) (New)

Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)

Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)

Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)

Elrexfio (elranatamab-bcmm) (Revised)

Elrexfio (elranatamab-bcmm) (Revised)

Papzimeos™ (zopapogene imadenovec-drba) (Revised)

Papzimeos™ (zopapogene imadenovec-drba) (New)

Kimmtrak (tebentafusp-tebn) (Revised)

Kimmtrak (tebentafusp-tebn) (Revised)

Asparlas™ (calaspargase pegol-mknl) (Revised)

Asparlas™ (calaspargase pegol-mknl) (Revised)

Asparlas™ (calaspargase pegol-mknl) (Revised)

Brekiya® (dihydroergotamine mesylate) (Revised)