Medicare AdvantagePrior AuthMedium impact
Besremi (ropeginterferon alfa-2b-njft) (Revised)
Humana·Hematology, Oncology·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Jul 28, 2026
Summary
Humana has revised its prior authorization policy for Besremi (ropeginterferon alfa-2b-njft), a medication for polycythemia vera. The policy requires prior authorization for both the prefilled syringe and pen injector formulations and maintains six specific exclusion criteria that must be reviewed before approval. Billing teams must ensure all Besremi claims include documented evidence that the member meets the single approval criterion (diagnosed polycythemia vera) and does not meet any exclusion criteria.
Action Required
By December 10, 2025: Billing team must update prior authorization protocols for Besremi to reflect the revised policy dated November 26, 2025. Specifically: (1) Configure billing system to flag all Besremi claims (both syringe and pen injector forms) for mandatory prior authorization before submission; (2) Create or update prior auth request checklist to verify member diagnosis of polycythemia vera and screen for all six exclusion criteria (hepatic decompensation Child-Pugh >6, severe psychiatric disorders/suicidal ideation, transplant immunosuppression, interferon hypersensitivity, active autoimmune disease, and prior disease progression on Besremi); (3) Update provider documentation templates to capture baseline psychiatric and autoimmune history required for prior auth review; (4) Communicate to clinical staff that initial approvals cover plan year duration and renewals follow annual review cycle. Claims submitted without prior authorization or incomplete exclusion screening will be denied.