MedicaidPrior AuthMedium impact
Gazyva® (obinutuzumab) (New)
Humana·OH · Hematology, Oncology, Rheumatology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Gazyva (obinutuzumab) covering three conditions: chronic lymphocytic leukemia, follicular lymphoma, and lupus nephritis for Ohio Medicaid patients. This establishes specific criteria, combination therapies, and approval duration requirements that must be met before coverage.
Action Required
Before February 1, 2026: Billing team must update prior authorization procedures for Gazyva (obinutuzumab) for Ohio Medicaid patients. Ensure providers document specific diagnosis criteria and required combination therapies (chlorambucil, bendamustine, Venclexta for CLL; chemotherapy combinations for follicular lymphoma; standard therapy for lupus nephritis). Train staff on exclusion criteria including disease progression history and 2-year maintenance therapy limits. Claims will be denied without proper prior authorization.