MedicaidPrior AuthMedium impact
Monjuvi® (tafasitamab-cxix) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Oct 1, 2025
We identified it
Jul 21, 2026
Summary
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.
Action Required
By October 1, 2025: Billing team must implement prior authorization process for Monjuvi (tafasitamab-cxix) in the billing system for Ohio Medicaid members. Create workflow to verify: (1) DLBCL or follicular lymphoma diagnosis; (2) relapsed/refractory disease status; (3) for DLBCL—ineligibility for ASCT and combination therapy with lenalidomide; (4) for follicular lymphoma—combination therapy with lenalidomide and rituximab; (5) no prior anti-CD19 therapy progression; (6) treatment duration does not exceed 12 cycles. Update encounter forms and prior auth templates to capture these clinical details. Providers must submit prior authorization requests before dispensing. Claims submitted without prior authorization approval will be denied. Coordinate with clinical review team on documentation requirements from providers.