MedicaidPrior AuthMedium impact
Lunsumio® & Lunsumio Velo™ (mosunetuzumab-axgb) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Lunsumio and Lunsumio Velo (mosunetuzumab-axgb) for treating relapsed or refractory follicular lymphoma. Prior authorization will be required starting May 1, 2026, with specific criteria including diagnosis confirmation, disease status, and previous treatment history.
Action Required
Before May 1, 2026: Billing team must implement prior authorization requirements for Lunsumio and Lunsumio Velo (mosunetuzumab-axgb) for Ohio Medicaid patients. Update billing system to flag these drugs and create documentation checklist requiring: follicular lymphoma diagnosis, relapsed/refractory disease status, at least two prior systemic therapies, and monotherapy use confirmation. Train oncology staff on new approval criteria and 6-month renewal requirements.