Traditional MedicarePrior AuthLow impact
Adakveo (crizanlizumab-tmca) (Revised)
Humana·KY, SC · Hematology, Oncology, Internal Medicine +2 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has revised their prior authorization policy for Adakveo (crizanlizumab-tmca), a medication for sickle cell disease. The policy now includes specific differences for Kentucky Medicaid requests and Medicare Part B continuation therapy exemptions. Key requirements include diagnosis of sickle cell disease, 2+ crises in past 12 months, and prior treatment with hydroxyurea and L-glutamine.
Action Required
By January 1, 2026: Billing team must update prior authorization processes for Adakveo (crizanlizumab-tmca) requests. Note that Kentucky Medicaid requests do not require step therapy with hydroxyurea and L-glutamine, while Medicare Part B continuation therapy within 365 days is exempt from step therapy. Ensure documentation includes sickle cell diagnosis, crisis history, and prior medication trials for approval.