Medicare AdvantagePrior AuthMedium impact
Deferasirox Products (New)
Humana·Hematology, Oncology, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has implemented a new prior authorization policy for deferasirox iron chelation products (Exjade, Jadenu) effective January 1, 2026, for Medicare Advantage plans. This policy requires specific clinical criteria including ferritin levels, diagnosis documentation, and platelet count thresholds to be met before approval.
Action Required
Before January 1, 2026: Billing and clinical teams must establish prior authorization workflows for all deferasirox products (Exjade, Jadenu). Providers must document ferritin levels >1000 mcg/L for transfusional iron overload or >300 mcg/L for non-transfusion dependent thalassemia, confirm platelet counts >50,000/microliter, and obtain liver iron concentration measurements where required. Update EMR templates to capture required clinical criteria. Claims will be denied without proper prior authorization.