Medicare AdvantagePrior AuthMedium impact
Blincyto® (blinatumomab) (Revised)
Humana·KY, SC · Oncology, Hematology, Pharmacy·Medicaid
Effective date
Jan 1, 2020
We identified it
Jul 22, 2026
Summary
This is a revised Blincyto (blinatumomab) pharmacy coverage policy for Humana Medicare and Medicaid (Kentucky and South Carolina) that maintains prior authorization requirements for three B-cell acute lymphoblastic leukemia (ALL) indications: relapsed/refractory disease, MRD-positive disease in remission, and consolidation phase treatment. The policy was last revised on July 22, 2026 (2 weeks ago) and includes black box warnings for cytokine release syndrome and neurological toxicities.
Action Required
Billing team must verify Blincyto claims meet one of three clinical criteria before submission: (1) relapsed/refractory Ph-negative or Ph-positive B-cell ALL as monotherapy or with tyrosine kinase inhibitors; (2) B-cell precursor ALL in first/second remission with MRD ≥0.1% as monotherapy or with tyrosine kinase inhibitors; or (3) B-cell precursor ALL in consolidation phase. All Blincyto requests require prior authorization from Humana before dispensing. Verify member is enrolled in Medicare or Medicaid (Kentucky or South Carolina only). Document clinical indication and disease status in prior auth request. Review updated policy at humana.com/PAL for current coding information. Failure to obtain prior authorization will result in claim denials.