Medicare AdvantagePrior AuthMedium impact
Olumiant (baricitinib) (Revised)
Humana·Rheumatology, Dermatology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jul 22, 2026
Summary
Humana revised its Olumiant (baricitinib) prior authorization policy for Medicare Advantage, effective January 1, 2026, with updates finalized July 22, 2026. The policy maintains prior authorization requirements for two indications: rheumatoid arthritis (requires failure/intolerance to two specific TNF antagonists or JAK inhibitors) and severe alopecia areata (requires 50%+ scalp hair loss and prior corticosteroid/cyclosporine failure). Billing teams must ensure claims include documentation of prior treatment history and severity criteria before submission.
Action Required
By January 1, 2026: Billing and clinical teams must implement prior authorization workflows for Olumiant prescriptions. (1) Rheumatoid Arthritis: Verify member has failed, has contraindication to, or is intolerant of TWO of the following before approving: adalimumab (Humira or biosimilars adalimumab-adbm, adalimumab-adaz), Enbrel, or Rinvoq. (2) Alopecia Areata: Verify diagnosis of severe alopecia areata with ≥50% scalp hair loss (documented via SALT score) for >6 months AND prior treatment failure/intolerance to corticosteroids (e.g., betamethasone valerate lotion) or cyclosporine capsules. Obtain and attach all prior treatment documentation to the prior authorization request submitted to Humana. Update encounter templates and PA request forms to capture treatment history. Staff must confirm latent TB testing has been performed and, if positive, TB treatment has been initiated before Olumiant begins. Monitor and document any serious infections, cardiovascular events, or thrombosis in member records. Failure to obtain prior authorization will result in claim denials.