MedicaidPrior AuthMedium impact
Monjuvi® (tafasitamab-cxix) (New)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Oct 1, 2025
We identified it
Jul 21, 2026
Summary
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.
Action Required
Before October 1, 2025: (1) Billing team must configure system to require prior authorization (PA) for all Monjuvi (tafasitamab-cxix) claims under Humana Medicaid Louisiana. (2) Providers must submit PA requests with documentation confirming: for DLBCL—diagnosis of relapsed/refractory DLBCL not otherwise specified, ineligibility for autologous stem cell transplant, no prior disease progression on anti-CD19 therapy, and planned 12-cycle combination with lenalidomide; for follicular lymphoma—diagnosis of relapsed/refractory FL and planned treatment with Monjuvi, lenalidomide, AND rituximab for no more than 12 cycles. (3) Front desk/authorization staff must route all Monjuvi requests to Humana Medicaid Louisiana PA team. (4) Update encounter forms and order entry systems to include treatment indication and combination therapy details. Failure to obtain PA before claim submission will result in denial. Initial and renewal approvals are limited to plan year duration or as determined by clinical review.