Medicare AdvantagePrior AuthMedium impact
Monjuvi® (tafasitamab-cxix) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Oct 14, 2020
We identified it
Jul 22, 2026
Summary
This is a revised Monjuvi (tafasitamab-cxix) prior authorization policy effective October 14, 2020, with the most recent revision dated July 22, 2026. The policy clarifies coverage criteria for two indications: (1) relapsed/refractory DLBCL in combination with lenalidomide for up to 12 cycles then as monotherapy for patients ineligible for autologous stem cell transplant, and (2) relapsed/refractory follicular lymphoma in combination with lenalidomide and rituximab with a maximum of 12 cycles total. All requests require prior authorization and must meet specific clinical criteria to avoid denial.
Action Required
By July 22, 2026 (or immediately if not already implemented): Billing and clinical teams must verify all Monjuvi (tafasitamab-cxix) requests meet prior authorization criteria before claim submission. For DLBCL cases: confirm diagnosis of relapsed/refractory disease, ineligibility for autologous stem cell transplant, and combination use with lenalidomide for maximum 12 cycles. For follicular lymphoma: confirm relapsed/refractory diagnosis and triple combination therapy (Monjuvi + lenalidomide + rituximab) with strict 12-cycle maximum. Flag any cases with prior anti-CD19-directed therapy progression (DLBCL exclusion) or exceeding 12-cycle duration (FL exclusion) for medical director review before submission. Update prior authorization templates in billing system to reflect both indication pathways. Train billing staff to identify which indication pathway applies to each authorization request. Claims submitted without meeting criteria or exceeding treatment limits will be denied. Reference www.humana.com/PAL for specific medical and procedural coding.