Medicare AdvantagePrior AuthMedium impact
Lymphir™ (denileukin diftitox-cxdl)
Humana·KY, SC · Oncology, Hematology·Medicaid
Effective date
Mar 25, 2026
We identified it
Jun 24, 2026
Summary
Humana has implemented a new prior authorization policy for Lymphir (denileukin diftitox-cxdl), a cancer medication for treating cutaneous T-cell lymphoma. This affects Medicare, Kentucky Medicaid, and South Carolina Medicaid plans requiring prior auth for patients with relapsed/refractory CTCL stages I-III who have had at least one prior systemic therapy.
Action Required
Before March 25, 2026: Billing team must update prior authorization requirements for Lymphir (denileukin diftitox-cxdl) in billing system for Medicare and Medicaid Kentucky/South Carolina plans. Providers must verify patient has relapsed/refractory CTCL stages I-III and prior systemic therapy before prescribing. Update encounter forms to include prior auth reminder. Visit www.humana.com/PAL for specific medical billing codes. Claims will be denied without proper prior authorization.