J7305 Insurance Policy Changes

Preferred Adalimumab Products (New)

Humana has established a new Prior Authorization policy for preferred adalimumab products (Humira and biosimilars) effective January 1, 2026, across 10 clinical indications. The policy defines specific clinical criteria for approval based on diagnosis severity, age requirements, and prior therapy requirements that vary by indication. Billing teams must implement prior authorization verification before dispensing these medications or claims will be denied.