MedicaidPrior AuthMedium impact
Monjuvi® (tafasitamab-cxix) (New)
Humana·IN · Hematology, Oncology·Medicaid
Effective date
Oct 1, 2025
We identified it
Jul 21, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Monjuvi® (tafasitamab-cxix), an anti-CD19 monoclonal antibody used to treat relapsed or refractory diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma. The policy requires prior authorization before dispensing and specifies strict criteria including disease type, refractoriness status, transplant ineligibility, and mandatory combination therapy protocols with maximum treatment durations.
Action Required
By October 1, 2025: Billing and clinical teams must implement prior authorization requirements for all Monjuvi (tafasitamab-cxix) requests under Humana Medicaid Indiana. (1) Update billing software to flag Monjuvi claims as requiring prior auth; (2) Providers must verify patient meets all four criteria for DLBCL (diagnosis of relapsed/refractory DLBCL not eligible for ASCT, using Monjuvi + lenalidomide for max 12 cycles) or all three criteria for follicular lymphoma (relapsed/refractory FL diagnosis, using Monjuvi + lenalidomide + rituximab product with max 12 cycle duration); (3) Ensure claims are not processed if patient has prior disease progression on anti-CD19 therapy (DLBCL) or total treatment exceeds 12 cycles (follicular lymphoma); (4) Submit prior authorization requests through Humana's PAL portal with diagnosis codes, treatment plan, and ASCT eligibility documentation; (5) Clinical staff should reference prescribing information for infusion-related reactions, myelosuppression, and infection monitoring requirements. Claims submitted without prior authorization or failing to meet criteria will be denied.