MedicaidPrior AuthMedium impact
Blincyto® (blinatumomab) (Revised)
Humana·IN · Hematology, Oncology, Pediatrics·Medicaid
Effective date
Oct 1, 2025
We identified it
Jul 21, 2026
Summary
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.
Action Required
By September 15, 2025: Billing team must implement prior authorization workflow for all Blincyto (blinatumomab) claims for Indiana Medicaid members. Verify patient eligibility against three coverage pathways: (1) Philadelphia chromosome-negative or positive relapsed/refractory B-cell ALL on monotherapy or with tyrosine kinase inhibitor (bosutinib, dasatinib, imatinib, nilotinib, or ponatinib); (2) MRD-positive B-cell precursor ALL in first or second complete remission (≥0.1% MRD level) on monotherapy or with tyrosine kinase inhibitor; (3) Consolidation phase multiphase chemotherapy for CD19-positive Philadelphia chromosome-negative B-cell precursor ALL. Obtain prior authorization from Humana before infusion. Update EMR/billing system to flag all Blincyto infusions as requiring pre-authorization. Train clinical staff on baseline bone marrow blast percentage requirements (≥10% for relapsed/refractory; <5% for MRD-positive). Provider must document complete remission status and MRD level in clinical notes. Claims submitted without prior authorization approval will be denied. Approval duration is plan year or as determined through clinical review.