Medicare AdvantagePrior AuthMedium impact
Rinvoq (upadacitinib) LQ Oral Solution (Revised)
Humana·Rheumatology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jul 23, 2026
Summary
Humana has issued a revised prior authorization policy for Rinvoq (upadacitinib) LQ Oral Solution effective January 1, 2026, with updates as of July 22, 2026. Coverage is limited to two indications: psoriatic arthritis and polyarticular juvenile idiopathic arthritis in patients age 2+ with prior TNF blocker failure, contraindication, or intolerance. Prior authorization is required for all Rinvoq LQ oral solution prescriptions under this policy.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirement for all Rinvoq (upadacitinib) LQ Oral Solution claims. Create a PA checklist requiring verification of: (1) diagnosis of psoriatic arthritis OR polyarticular juvenile idiopathic arthritis, (2) patient age 2 years or older, and (3) documented prior therapy, contraindication, or intolerance with one or more TNF blockers (Humira, adalimumab-adbm, adalimumab-adaz, or Enbrel). Update billing system to flag Rinvoq LQ oral solution as requiring PA before submission. Route all requests through the prior authorization workflow. Train providers and front-desk staff on documentation requirements. Claims submitted without meeting all three criteria or without PA approval will be denied.