Medicare AdvantagePrior AuthHigh impact
Enbrel (etanercept) (New)
Humana·Rheumatology, Dermatology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Enbrel (etanercept) effective January 1, 2026. All Enbrel prescriptions for Medicare Advantage patients will require prior authorization approval based on specific diagnosis and age criteria for six covered conditions.
Action Required
By January 1, 2026: Billing team must update systems to flag all Enbrel prescriptions for Medicare Advantage patients as requiring prior authorization. Providers must ensure patients meet specific age and diagnosis criteria before prescribing. Update encounter forms to remind providers of prior auth requirement for rheumatology, dermatology, and pediatric patients. Claims will be denied without proper prior authorization approval.