Medicare AdvantagePrior AuthMedium impact
Rhapsido® (remibrutinib) (New)
Humana·Allergy & Immunology, Dermatology, Family Medicine +1 more·Medicare Advantage
Effective date
Feb 25, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Rhapsido (remibrutinib), a medication for chronic spontaneous urticaria. The policy requires specific criteria including failed H1 antihistamine therapy and previous treatment with or contraindication to Dupixent before approval.
Action Required
By February 25, 2026: Billing and clinical teams must implement prior authorization requirements for Rhapsido (remibrutinib) prescriptions for Medicare Advantage patients. Providers must document: 1) chronic spontaneous urticaria diagnosis, 2) at least 2 weeks of failed H1 antihistamine therapy, 3) continued H1 antihistamine use plan, and 4) previous Dupixent treatment/contraindication/intolerance. Update EMR templates to capture required criteria. Claims without prior authorization will be denied.