MedicaidPrior AuthLow impact
Besponsa™ (inotuzumab ozogamicin) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Besponsa (inotuzumab ozogamicin), a specialized cancer medication for B-cell precursor acute lymphoblastic leukemia. This drug requires prior authorization starting January 1, 2026, with specific clinical criteria including relapsed/refractory disease and CD22 blast documentation.
Action Required
Before January 1, 2026: Billing and clinical teams treating acute lymphoblastic leukemia patients must establish prior authorization workflow for Besponsa (inotuzumab ozogamicin) for Ohio Medicaid patients. Ensure documentation includes B-cell precursor ALL diagnosis, relapsed/refractory status, CD22 blasts in bone marrow or peripheral blood, and monotherapy use. Update EMR templates to capture required clinical criteria. Claims without prior authorization will be denied.