All Insurance Policy Changes (Page 156)

Continuing from page 155. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
Fibrate Products (Revised)
Humana·Effective Jan 1, 2017
Humana Medicare Advantage has revised its Fibrate Products step therapy policy (effective 1/1/2017, revised 11/26/2025). The policy implements a step therapy requirement for fenofibrate micronized capsules, requiring members to have prior treatment with both a generic fenofibrate micronized capsule (67mg, 134mg, or 200mg) AND a generic fenofibrate tablet (48mg, 54mg, 145mg, or 160mg) before approval. This is a FRESH 1-DAY-OLD revision requiring immediate attention.
Medium impact
Diabetic Test Strips and Meters (Revised)
Humana·Effective Jan 1, 2017
This is a revised Humana Medicare Advantage pharmacy coverage policy for diabetic test strips and meters effective January 1, 2017, with a recent revision date of June 24, 2026. The policy maintains prior authorization requirements for a comprehensive list of over 150 glucose monitoring products and test strips across multiple brands. No specific coverage changes are detailed in the extracted content, but the recent revision indicates policy review and potential updates to the covered product formulary.
Medium impact
Cycloset® (bromocriptine) (Revised)
Humana·Effective Jan 1, 2017
Humana updated its Cycloset (bromocriptine) step therapy policy effective January 1, 2017, with a revision date of September 24, 2025. The policy clarifies that automatic approval is granted to Medicare Advantage members who have previous treatment with, contraindication to, or intolerance to metformin-containing medicines. Initial and renewal approvals are granted for plan year durations or as determined through clinical review. This is a step therapy policy requiring prior authorization for Cycloset in Medicare Advantage plans.
Medium impact
Bisphosphonates (Revised)
Humana·Effective Jan 1, 2017
Humana has revised its Bisphosphonates (Binosto, Fosamax, Fosamax Plus D) pharmacy coverage policy for Medicare Advantage, effective January 1, 2017, with the most recent revision dated February 25, 2026. This is a Step Therapy policy requiring members to have previous treatment or intolerance to alendronate before approval. The policy includes extensive contraindications and cautions regarding patient eligibility, including restrictions for severe renal insufficiency, GI abnormalities, hypocalcemia, and conditions increasing osteonecrosis of the jaw risk.
Medium impact
Von Willebrand Factor (VWF)-Containing Products (Revised)
Humana·Identified Jun 25, 2026
Failed to analyze policy change
Medium impact
Obizur [antihemophilic (recombinant), porcine sequence] (Revised)
Humana·Effective Apr 22, 2026
Humana revised its Obizur (antihemophilic factor recombinant, porcine sequence) pharmacy coverage policy for Kentucky Medicare and Medicaid members. This is a FRESH POLICY UPDATE (1 day old) requiring prior authorization for on-demand treatment of acquired hemophilia A bleeding episodes. The policy clarifies eligibility criteria, dosing requirements, and contraindications, with critical emphasis on confirming acquired hemophilia A diagnosis and active bleeding status before authorization.
Medium impact
NovoSeven RT and SevenFact (Recombinant Activated Factor VIIa) (Revised)
Humana·Effective Apr 22, 2026
Humana has revised its prior authorization policy for NovoSeven RT and SevenFact (recombinant activated Factor VIIa) effective April 22, 2026, covering treatment of bleeding episodes and perioperative management in patients with hemophilia with inhibitors, congenital Factor VII deficiency, and Glanzmann's thrombasthenia with platelet refractoriness. The policy applies to Kentucky Medicaid and Medicare lines of business and requires prior authorization before dispensing these specialty coagulation factors.
Medium impact
Factor VIII Replacement Products (Hemophilia A) (Revised)
Humana·Effective Dec 17, 2025
This is a revised Factor VIII replacement product prior authorization policy for Hemophilia A treatment, effective January 20, 2017, with most recent updates on December 17, 2025. The policy covers 18 Factor VIII products across two main indications: routine bleeding prophylaxis and on-demand bleeding control/perioperative management. All Factor VIII product requests now require prior authorization approval with specific clinical criteria documentation for Medicaid/Medicare Kentucky members.
Medium impact
Factor IX Replacement Products (Hemophilia B) (Revised)
Humana·Effective Jan 20, 2017
This is a revised Humana Medicaid policy (Kentucky) for Factor IX replacement products used to treat Hemophilia B. The policy was last revised on December 17, 2025 (1 day old) and requires prior authorization for eight Factor IX products. No substantive coverage changes are documented in this revision; the policy maintains existing approval criteria requiring confirmed congenital Hemophilia B diagnosis and use for prophylaxis, on-demand bleeding treatment, or perioperative management.
Medium impact
Corifact® (Factor XIII Concentrate [Human]) (Revised)
Humana·Effective Dec 17, 2025
Humana revised its Corifact® (Factor XIII Concentrate [Human]) prior authorization policy for Kentucky Medicaid and Medicare effective December 17, 2025. The policy clarifies coverage is limited to patients with congenital Factor XIII deficiency for routine prophylactic treatment or peri-operative management of surgical bleeding, requiring prior authorization. Billing teams must ensure all Corifact claims include proper diagnosis coding and prior authorization before submission.
Low impact
Coagadex® (Coagulation Factor X [Human]) (Revised)
Humana·Effective Dec 17, 2025
Humana revised its Coagadex (Coagulation Factor X [Human]) pharmacy coverage policy effective December 17, 2025, covering Medicare and Medicaid members in Kentucky and South Carolina. The policy maintains prior authorization requirements for this blood coagulation factor used to treat hereditary Factor X deficiency. No substantive coverage criteria changes are evident; the revision appears to be a routine update of existing policy language and references.
Medium impact
Xermelo™ (telotristat ethyl) (Revised)
Humana·Effective Apr 5, 2017
Humana Medicare Advantage updated the Xermelo (telotristat ethyl) prior authorization policy on October 22, 2025. The policy maintains existing coverage criteria for carcinoid syndrome diarrhea treatment but reinforces that prior authorization is required for initial approval (6 months) and renewal (6 months), with specific clinical criteria that must be met including 3 months of prior SSA therapy at stable dose and concomitant SSA use. The revision date indicates this is a current, active policy requiring immediate compliance.
Medium impact
Xadago® (safinamide) (Revised)
Humana·Effective Oct 22, 2025
Humana Medicare Advantage updated its Xadago (safinamide) prior authorization policy on October 22, 2025. The policy requires prior authorization for this Parkinson's disease medication, with four specific approval criteria including confirmation of Parkinson's diagnosis, use with levodopa/carbidopa, active 'off' episodes, and documented failure or contraindication to selegiline AND rasagiline. No billing codes are specified in the policy document.
Low impact
Brineura™ (cerliponase alfa) (Revised)
Humana·Effective Mar 25, 2026
Humana revised its Brineura™ (cerliponase alfa) prior authorization policy for rare pediatric CLN2 disease treatment. The policy now applies to Medicare, Medicaid-Kentucky, and Medicaid-South Carolina lines of business. No specific billing code changes are documented, but this ultra-rare orphan drug requires strict prior authorization compliance with three clinical criteria before coverage.
Low impact
Tretten® (Coagulation Factor XIII A-Subunit [Recombinant]) (Revised)
Humana·Effective Dec 17, 2025
Humana revised its Tretten® (Coagulation Factor XIII A-Subunit [Recombinant]) prior authorization policy effective December 17, 2025. This is a pharmacy coverage policy requiring prior authorization for Tretten use in patients with congenital factor XIII A-subunit deficiency for routine prophylaxis of bleeding. The policy applies to Medicare and Medicaid (Kentucky and South Carolina) plans.
Medium impact
FEIBA NF (Anti-Inhibitor Coagulant Complex) (Revised)
Humana·Effective Jul 20, 2017
This is a revised Humana Medicaid pharmacy policy for FEIBA NF (Anti-Inhibitor Coagulant Complex) effective July 20, 2017, with the most recent revision dated April 22, 2026. The policy establishes prior authorization requirements for FEIBA NF in Kentucky Medicaid members with hemophilia A or B who have developed inhibitors to factor VIII or IX. Coverage is limited to three indications: control and prevention of bleeding episodes, perioperative management, and routine prophylaxis. The policy includes a black box warning for thromboembolic events and specifies dosing restrictions (maximum 200 units/kg/day).
Medium impact
Vyxeos™ (daunorubicin and cytarabine) liposome (Revised)
Humana·Effective Feb 25, 2026
Humana revised its Vyxeos (daunorubicin and cytarabine liposome) prior authorization policy effective February 25, 2026. The policy clarifies coverage is limited to newly diagnosed therapy-related AML (t-AML) or AML with myelodysplasia-related changes (AML-MRC), with specific approval durations of 6 months per cycle (maximum 2 induction and 2 consolidation cycles). Coverage is denied if members have experienced disease progression on Vyxeos or conventional daunorubicin/cytarabine regimens. This revision updates clinical criteria and approval parameters for Medicaid and Medicare members.
Medium impact
Kymriah™ (tisagenlecleucel) (Revised)
Humana·Effective Feb 19, 2026
Humana Medicare Advantage has revised its Kymriah (tisagenlecleucel) prior authorization policy effective February 19, 2026. The policy maintains coverage for three indications: diffuse large B-cell lymphoma (DLBCL), acute lymphoblastic leukemia (ALL), and follicular lymphoma, with specific clinical criteria and a lifetime maximum of one dose per indication. Billing teams must ensure prior authorization is obtained before claims are submitted, and must verify all clinical criteria are met before proceeding with treatment.
Medium impact
XHANCE® (fluticasone propionate) (Revised)
Humana·Effective Apr 22, 2026
Humana updated its XHANCE (fluticasone propionate) prior authorization policy effective April 22, 2026. For CRSwNP (with nasal polyps), members now require documentation of previous treatment/contraindication/intolerance with TWO of three specific intranasal products (fluticasone propionate, mometasone, Qnasl) before approval. For CRSsNP (without nasal polyps), only a diagnosis of chronic rhinosinusitis without nasal polyps is required. This revision clarifies coverage criteria and tightens authorization requirements for the nasal spray therapy.
Medium impact
Yescarta™ (axicabtagene ciloleucel) (Revised)
Humana·Effective Feb 19, 2026
Humana revised its Yescarta (axicabtagene ciloleucel) prior authorization policy effective February 19, 2026, clarifying coverage criteria for three indications: large B-cell lymphoma (3L+), large B-cell lymphoma (2L), and follicular lymphoma. The policy maintains a lifetime limit of one dose per member and requires lymphodepleting chemotherapy unless contraindicated. All requests must be routed to the Corporate Transplant Department.
Low impact
Mepsevii™ (vestronidase alfa-vjbk) (Revised)
Humana·Effective Apr 22, 2026
Humana revised its Mepsevii (vestronidase alfa-vjbk) prior authorization policy effective April 22, 2026, for Medicare and Medicaid members in Kentucky and South Carolina. The policy requires prior authorization for this rare enzyme replacement therapy used to treat Mucopolysaccharidosis VII (MPS VII/Sly syndrome). The primary approval criterion is confirmation of MPS VII diagnosis. Key safety requirement: Mepsevii must be administered under healthcare professional supervision due to black box warning for anaphylaxis risk.
Medium impact
Aliqopa™ (copanlisib) (Revised)
Humana·Effective Jul 23, 2025
Humana updated its Aliqopa (copanlisib) prior authorization policy for Medicare Advantage members with relapsed follicular lymphoma. The policy requires prior authorization and establishes specific approval criteria: diagnosis of follicular lymphoma, relapsed/refractory/progressive disease, at least two prior systemic therapies, and monotherapy use only. Claims will be denied if members have experienced disease progression on prior PI3K inhibitors.
Medium impact
Trisenox® (arsenic trioxide) (Revised)
Humana·Effective Jan 28, 2026
Humana revised its Trisenox (arsenic trioxide) prior authorization policy effective January 28, 2026. The policy covers intravenous arsenic trioxide for acute promyelocytic leukemia (APL) requiring prior authorization for induction therapy, consolidation therapy, or relapsed disease across Medicare and four state Medicaid programs. The revision date of January 28, 2026 indicates recent updates to clinical guidance, warnings, or approval criteria that billing teams must implement immediately.
Low impact
Thrombate III® [Antithrombin III (Human)] (Revised)
Humana·Effective Jan 1, 2018
This is a routine policy revision for Thrombate III (Antithrombin III Human) effective January 1, 2018, with the most recent update dated August 27, 2025. The policy maintains prior authorization requirements for Medicaid members in Florida, Kentucky, and Virginia (plus Medicare) with hereditary antithrombin deficiency. No substantive coverage changes are documented in this revision—it appears to be a standard periodic review update.
Medium impact
Oncaspar® (pegaspargase) (Revised)
Humana·Effective Jan 1, 2018
Humana revised its Oncaspar (pegaspargase) prior authorization policy effective January 1, 2018, with the most recent revision on December 17, 2025. The policy clarifies coverage criteria for pegaspargase as part of multi-agent chemotherapy for acute lymphoblastic leukemia (ALL), requires prior authorization, and specifies five clinical exclusions (disease progression on prior Oncaspar, thrombosis history, pancreatitis history, hemorrhagic events history, and elevated bilirubin >10x ULN). Approval duration is 6 months initially and on renewal, subject to clinical review.

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Archive by year

2023 2024 2025 2026

Fibrate Products (Revised)

Diabetic Test Strips and Meters (Revised)

Cycloset® (bromocriptine) (Revised)

Bisphosphonates (Revised)

Von Willebrand Factor (VWF)-Containing Products (Revised)

Obizur [antihemophilic (recombinant), porcine sequence] (Revised)

NovoSeven RT and SevenFact (Recombinant Activated Factor VIIa) (Revised)

Factor VIII Replacement Products (Hemophilia A) (Revised)

Factor IX Replacement Products (Hemophilia B) (Revised)

Corifact® (Factor XIII Concentrate [Human]) (Revised)

Coagadex® (Coagulation Factor X [Human]) (Revised)

Xermelo™ (telotristat ethyl) (Revised)

Xadago® (safinamide) (Revised)

Brineura™ (cerliponase alfa) (Revised)

Tretten® (Coagulation Factor XIII A-Subunit [Recombinant]) (Revised)

FEIBA NF (Anti-Inhibitor Coagulant Complex) (Revised)

Vyxeos™ (daunorubicin and cytarabine) liposome (Revised)

Kymriah™ (tisagenlecleucel) (Revised)

XHANCE® (fluticasone propionate) (Revised)

Yescarta™ (axicabtagene ciloleucel) (Revised)

Mepsevii™ (vestronidase alfa-vjbk) (Revised)

Aliqopa™ (copanlisib) (Revised)

Trisenox® (arsenic trioxide) (Revised)

Thrombate III® [Antithrombin III (Human)] (Revised)

Oncaspar® (pegaspargase) (Revised)