MedicaidPrior AuthMedium impact
Blincyto® (blinatumomab) (Revised)
Humana·OH · Oncology, Hematology, Pediatrics·Medicaid
Effective date
Oct 1, 2025
We identified it
Jul 21, 2026
Summary
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.
Action Required
Before October 1, 2025: Billing team must configure the prior authorization system to require approval for all Blincyto (blinatumomab) intravenous kit and intravenous solution claims submitted for Ohio Medicaid members. Clinical staff must verify that prescribing providers document one of the three qualifying indications: (1) relapsed/refractory B-cell ALL with monotherapy or tyrosine kinase inhibitor combination, (2) MRD-positive B-cell precursor ALL in first or second complete remission, or (3) consolidation phase B-cell precursor ALL. Ensure prior authorization requests include diagnosis confirmation and treatment regimen details. Train front-desk and clinical staff on the black box warnings for Cytokine Release Syndrome and Neurological Toxicities. Update encounter templates to flag Blincyto requests for prior authorization routing. Claims submitted without prior authorization will be denied. Reference www.humana.com/PAL for medical claim codes if medically billed.