MedicaidPrior AuthMedium impact
Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta) (Revised)
Humana·LA · Hematology, Oncology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Louisiana Medicaid has revised their prior authorization policy for bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta) used to treat various blood cancers and lymphomas. The policy updates specific coverage criteria for each indication including CLL, multiple myeloma, Hodgkin lymphoma, non-Hodgkin lymphoma, and Waldenström's macroglobulinemia, with plan year duration approvals for initial and renewal requests.
Action Required
By January 1, 2026: Billing and prior authorization teams must update procedures for bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta) for Louisiana Medicaid members. Ensure prior authorization requests include specific diagnosis documentation and confirm the patient meets indication-specific criteria (appropriate line of therapy, disease status). Verify patients have not previously experienced disease progression on bendamustine-containing regimens as this is an exclusion criterion. Update authorization tracking to reflect plan year duration approvals.