Rinvoq (upadacitinib) Extended Release Tablet (Revised)

By January 1, 2026: Billing and authorization team must implement prior authorization requirements for all Rinvoq (upadacitinib) extended release tablet claims submitted to Humana Medicare Advantage plans. Specific actions: (1) Update billing system to flag all Rinvoq claims for mandatory prior authorization review; (2) Create authorization checklist requiring verification of: diagnosis (moderate-to-severe disease or active disease as specified per indication), member age requirements (varies by indication: age 2+ for psoriatic arthritis and polyarticular juvenile idiopathic arthritis; age 12+ for atopic dermatitis; age 18+ for all others), and prior therapy history (TNF blocker failure/contraindication/intolerance required for most indications; for atopic dermatitis, requires prior systemic therapy; for ulcerative colitis and Crohn's disease, accepts TNF blocker failure OR approved systemic therapy); (3) Update encounter forms and prior auth request templates to include these criteria; (4) Train providers and front desk staff to collect and document required information before claim submission; (5) Route all Rinvoq requests to authorized personnel for verification before claim processing. Failure to obtain prior authorization will result in claim denials. Note: Giant Cell Arteritis indication requires only diagnosis and age 18+ verification (no prior therapy requirement).