Medicare AdvantagePrior AuthHigh impact
Taltz (ixekizumab) (Revised)
Humana·Dermatology, Rheumatology, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jul 2, 2026
Summary
Humana has issued a revised prior authorization policy for Taltz (ixekizumab) effective January 1, 2026, with updates as of June 24, 2026. The policy requires prior authorization for Taltz across four indications (psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis) with specific criteria requiring documented failure, contraindication, or intolerance to two preferred biologic agents before approval. Billing teams must ensure all Taltz requests include evidence of prior therapy attempts with the specified biologics or documented contraindications.
Action Required
By January 1, 2026: Billing team and clinical staff must implement mandatory prior authorization workflow for all Taltz (ixekizumab) claims (HCPCS J2507). Before submitting any Taltz authorization request, verify: (1) member meets age requirements (18+ for arthritis/spondylitis indications; 6+ for plaque psoriasis), (2) documented diagnosis matches one of four covered indications, and (3) medical record includes evidence of prior therapy failure or documented contraindication/intolerance to TWO agents from the specified list for each indication. For psoriatic arthritis and plaque psoriasis, required prior agents include: preferred adalimumab products, Enbrel, Cosentyx, preferred ustekinumab products, and others per indication. Update authorization templates and EMR/billing system to enforce this two-agent requirement. Train providers and front-desk staff on documentation requirements. Claims submitted without evidence of required prior therapy attempts will be denied. Submit all authorization requests through www.humana.com/PAL using applicable Preauthorization and Notification List codes.