Medicare AdvantagePrior AuthMedium impact
Umbilical Cord Blood Transplantation - Medicare Advantage (Revised)
Humana·Hematology, Oncology, Transplant Surgery·Pharmacy
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new coverage criteria for two umbilical cord blood transplantation products: Omisirge (for patients 12+ with hematologic malignancies or 6+ with severe aplastic anemia) and Regenecyte (for patients 65 and under with hematopoietic system disorders). Both products require medical director review through the Corporate Transplant Department.
Action Required
Before June 1, 2026: Billing team must update systems to route all Omisirge and Regenecyte requests to Corporate Transplant Department (1-866-421-5663, transplant@humana.com) for medical director review. Update encounter forms to capture age requirements and specific diagnoses for coverage determination. Document contraindications including pregnancy/breastfeeding status and renal disease for proper prior authorization.