Medicare AdvantagePrior AuthMedium impact
Benlysta® (belimumab) (Revised)
Humana·Rheumatology, Nephrology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Benlysta (belimumab) for treating systemic lupus erythematosus (SLE) and lupus nephritis. The policy establishes specific criteria including age requirements (5+ years), autoantibody positivity thresholds, and combination therapy requirements for coverage approval.
Action Required
Before January 1, 2026: Billing team must implement prior authorization requirements for all Benlysta (belimumab) prescriptions for Humana Medicare Advantage patients. Ensure providers document: 1) SLE or lupus nephritis diagnosis, 2) Patient age 5+ years, 3) Autoantibody test results (ANA titer ≥1:80 or anti-dsDNA ≥30 IU/mL for SLE), 4) Combination with standard therapies, and 5) Absence of severe active CNS lupus. Update prior auth workflow to capture these criteria.