All Insurance Policy Changes (Page 213)

Continuing from page 212. 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
Imbruvica® (ibrutinib) (Revised)
Humana·Effective Jan 1, 2026
Humana has updated their prior authorization policy for Imbruvica (ibrutinib), a medication used to treat various blood cancers and chronic graft versus host disease. The policy specifies coverage criteria for four conditions: chronic lymphocytic leukemia/small lymphocytic lymphoma, Waldenstrom's macroglobulinemia, marginal zone lymphoma, and chronic graft versus host disease, with specific exclusions for patients who have experienced disease progression while on this medication.
High impact
IVIG (immune globulin) (Revised)
Humana·Effective Jan 1, 2026
Humana has revised their IVIG (immune globulin) prior authorization policy for Ohio Medicaid, effective January 1, 2026. The policy establishes preferred products and specific criteria for 24 covered conditions including primary immunodeficiency, ITP, and various autoimmune disorders.
High impact
IVIG (immune globulin)
Humana·Effective Jan 1, 2026
Humana has implemented a comprehensive prior authorization policy for IVIG (immune globulin) products effective January 1, 2026, covering multiple Medicare and Medicaid lines of business. The policy establishes preferred product lists, specific clinical criteria for 25+ medical conditions, and requires prior authorization for all IVIG treatments with detailed approval criteria for each indication.
High impact
IVIG (immune globulin) (New)
Humana·Effective Jan 1, 2026
Humana implemented a new comprehensive prior authorization policy for IVIG (immune globulin) products effective January 1, 2026, covering 25+ medical conditions including primary immunodeficiency, ITP, CLL, and various autoimmune disorders. The policy establishes specific coverage criteria, preferred product lists, and step therapy requirements for Virginia Medicaid patients.
Medium impact
Harvoni (ledipasvir/sofosbuvir) (Revised)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage has updated their prior authorization policy for Harvoni (hepatitis C treatment), now requiring patients to have failed or have contraindications to Epclusa before Harvoni can be approved. This adds a new step-therapy requirement that wasn't previously specified.
Medium impact
Granix® (tbo-filgrastim) (Revised)
Humana·Effective Jan 1, 2026
Granix (tbo-filgrastim) now requires prior authorization for Medicaid patients in Kentucky and South Carolina. Patients must have tried and failed Zarxio and Nivestym before Granix can be approved, along with meeting specific cancer diagnosis and neutropenia risk criteria.
Medium impact
Granix® (tbo-filgrastim) (Revised)
Humana·Effective Jan 1, 2026
Humana revised their prior authorization policy for Granix (tbo-filgrastim), a medication used to prevent febrile neutropenia in cancer patients receiving chemotherapy. The policy establishes specific risk-based criteria and requires trial of preferred alternatives (Zarxio for medical benefit, Zarxio/Nivestym for Part D) before approving Granix.
Medium impact
GnRH Receptor Antagonists (Myfembree®, Oriahnn®) (New)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage now requires prior authorization for GnRH receptor antagonists (Myfembree and Oriahnn) used to treat heavy menstrual bleeding from uterine fibroids and endometriosis pain. Specific medical criteria must be met including prior treatment failures and exclusions for osteoporosis.
Medium impact
GnRH Receptor Antagonists (Myfembree®, Oriahnn®) (New)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage now requires prior authorization for GnRH receptor antagonists (Myfembree and Oriahnn) used to treat heavy menstrual bleeding from uterine fibroids and endometriosis pain. Approval requires specific diagnosis criteria, previous treatment failures, and excludes patients with osteoporosis.
Medium impact
GnRH Receptor Antagonists (Myfembree®, Oriahnn®) (New)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage has implemented a new prior authorization requirement effective January 1, 2026 for GnRH receptor antagonists Myfembree and Oriahnn. These medications treat heavy menstrual bleeding from uterine fibroids and endometriosis pain, requiring specific diagnostic criteria, previous treatment failures, and excluding patients with osteoporosis.
Medium impact
Glucagon Products (Revised)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage now requires step therapy for glucagon products used to treat severe hypoglycemia (diabetes emergencies). Patients must try Baqsimi nasal spray first before other glucagon products like Gvoke injections and emergency kits will be covered.
Medium impact
Genetic Testing for Diagnosis of Inherited Conditions - MEDICAID - MICHIGAN (New)
Humana·Effective Jan 1, 2026
Michigan Medicaid (Humana) is implementing a new policy for genetic testing coverage for inherited conditions including CANVAS, corneal dystrophy, DRPLA, glycogen storage disease, and other genetic disorders. The policy establishes specific coverage criteria requiring pre- and post-test genetic counseling and detailed clinical documentation for various genetic tests.
Low impact
Fyarro (sirolimus protein-bound particles for injectable suspension) (Revised)
Humana·Effective Jan 1, 2026
Humana Indiana Medicaid has established a new prior authorization policy for Fyarro (sirolimus protein-bound particles), a cancer treatment for perivascular epithelioid cell tumors. Prior authorization will be required starting January 1, 2026, with specific criteria including locally advanced unresectable or metastatic diagnosis and monotherapy administration.
Low impact
Fyarro (sirolimus protein-bound particles for injectable suspension) (Revised)
Humana·Effective Jan 1, 2026
Humana Medicaid Louisiana has established a new prior authorization policy for Fyarro (sirolimus protein-bound particles for injectable suspension), an mTOR inhibitor used to treat locally advanced unresectable or metastatic perivascular epithelioid cell tumors (PEComa). The policy requires prior authorization for this specialty oncology drug with specific clinical criteria including confirmed diagnosis and monotherapy administration.
Medium impact
Fosaprepitant products (Emend, Focinvez) (New)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage now requires prior authorization for fosaprepitant products (Emend, Focinvez) used to prevent chemotherapy-induced nausea and vomiting. Coverage requires specific criteria including use with highly or moderately emetogenic chemotherapy and combination with corticosteroids and 5-HT3 antagonists.
Medium impact
Forteo® (teriparatide injection) (Revised)
Humana·Effective Jan 1, 2026
Humana revised its Medicare Advantage prior authorization policy for Forteo (teriparatide injection) for osteoporosis treatment, with new risk stratification criteria including 'VERY HIGH risk' categories and updated approval requirements. The policy is effective January 1, 2026 and includes specific criteria for postmenopausal, glucocorticoid-induced, and primary/hypogonadal osteoporosis.
Medium impact
Folotyn® (pralatrexate) (New)
Humana·Effective Jan 1, 2026
Humana Indiana Medicaid has introduced a new prior authorization policy for Folotyn (pralatrexate), a chemotherapy drug used to treat relapsed or refractory peripheral T-cell lymphoma. Prior authorization is required for both brand and generic pralatrexate intravenous solutions effective January 1, 2026.
Low impact
Folotyn® (pralatrexate) (New)
Humana·Effective Jan 1, 2026
Humana Medicaid Louisiana has implemented a new prior authorization policy for Folotyn (pralatrexate) effective January 1, 2026. This medication requires prior authorization for treatment of relapsed or refractory peripheral T-cell lymphoma, with specific criteria that must be met before approval.
Low impact
Folotyn® (pralatrexate) (New)
Humana·Effective Jan 1, 2026
Humana Medicaid Ohio has implemented a new prior authorization policy for Folotyn (pralatrexate) effective January 1, 2026. This IV medication for relapsed or refractory peripheral T-cell lymphoma now requires prior authorization approval demonstrating the specific indication and that the patient hasn't experienced disease progression on this medication.
Medium impact
Firmagon (degarelix) (Revised)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage now requires prior authorization for Firmagon (degarelix) injections used to treat advanced prostate cancer. The policy requires diagnosis of advanced prostate cancer or high risk of disease recurrence, and excludes concomitant use with other LHRH analogs.
Low impact
Firazyr (icatibant) (New)
Humana·Effective Jan 1, 2026
Humana Medicaid Indiana has implemented a new prior authorization policy for Firazyr (icatibant) and related medications used to treat hereditary angioedema (HAE). The policy requires extensive documentation including lab values, specialist treatment, and specific clinical criteria to be met before approval.
Low impact
Fensolvi® (leuprolide acetate) subcutaneous syringe (New)
Humana·Effective Jan 1, 2026
Humana Indiana Medicaid has established a new prior authorization policy for Fensolvi® (leuprolide acetate) subcutaneous syringe, effective January 1, 2026. This medication requires prior authorization for pediatric patients 2+ years old with central precocious puberty, with approvals granted for plan year durations.
Medium impact
Felbatol® (felbamate) (New)
Humana·Effective Jan 1, 2026
Humana Medicare Advantage now requires prior authorization for Felbatol (felbamate) prescriptions for Lennox-Gastaut Syndrome and partial-onset seizures. Providers must meet specific clinical criteria including specialist consultation, failed trials of other medications, and normal liver function tests.
Medium impact
Felbatol® (felbamate) (New)
Humana·Effective Jan 1, 2026
New prior authorization policy for Felbatol (felbamate) effective January 1, 2026 for Medicare Advantage plans. Requires specialist prescription and documentation that patient has failed at least two other seizure medications before approval.
Low impact
Evkeeza™ (evinacumab-dgnb) (Revised)
Humana·Effective Jan 1, 2026
Humana Medicaid Ohio has implemented a new prior authorization policy for Evkeeza (evinacumab-dgnb), an IV medication for treating Homozygous Familial Hypercholesterolemia (HoFH). Prior authorization will be required for this specialty cholesterol medication starting January 1, 2026.

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Archive by year

2023 2024 2025 2026

Imbruvica® (ibrutinib) (Revised)

IVIG (immune globulin) (Revised)

IVIG (immune globulin)

IVIG (immune globulin) (New)

Harvoni (ledipasvir/sofosbuvir) (Revised)

Granix® (tbo-filgrastim) (Revised)

Granix® (tbo-filgrastim) (Revised)

GnRH Receptor Antagonists (Myfembree®, Oriahnn®) (New)

GnRH Receptor Antagonists (Myfembree®, Oriahnn®) (New)

GnRH Receptor Antagonists (Myfembree®, Oriahnn®) (New)

Glucagon Products (Revised)

Genetic Testing for Diagnosis of Inherited Conditions - MEDICAID - MICHIGAN (New)

Fyarro (sirolimus protein-bound particles for injectable suspension) (Revised)

Fyarro (sirolimus protein-bound particles for injectable suspension) (Revised)

Fosaprepitant products (Emend, Focinvez) (New)

Forteo® (teriparatide injection) (Revised)

Folotyn® (pralatrexate) (New)

Folotyn® (pralatrexate) (New)

Folotyn® (pralatrexate) (New)

Firmagon (degarelix) (Revised)

Firazyr (icatibant) (New)

Fensolvi® (leuprolide acetate) subcutaneous syringe (New)

Felbatol® (felbamate) (New)

Felbatol® (felbamate) (New)

Evkeeza™ (evinacumab-dgnb) (Revised)