Medicare AdvantagePrior AuthMedium impact
Dasatinib products (Revised)
Humana·Hematology, Oncology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana updated prior authorization requirements for dasatinib products (Sprycel, Phyrago, generic dasatinib) for Medicare Advantage plans, establishing specific criteria for adult and pediatric patients with chronic myelogenous leukemia, acute lymphoblastic leukemia, and gastrointestinal stromal tumors. The policy requires brand products only when patients have contraindications or intolerance to generic dasatinib.
Action Required
By January 1, 2026: Billing and prior authorization teams must update procedures to obtain prior authorization for all dasatinib products (Sprycel, Phyrago, generic dasatinib) for Medicare Advantage patients. Verify patients meet specific diagnostic criteria including Philadelphia chromosome status, disease phase, and prior treatment history. For brand products, document contraindication or intolerance to generic dasatinib. Claims without proper prior authorization will be denied.