Medicare AdvantagePrior AuthMedium impact
Imbruvica® (ibrutinib) (Revised)
Humana·Hematology, Oncology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has updated their prior authorization policy for Imbruvica (ibrutinib), a medication used to treat various blood cancers and chronic graft versus host disease. The policy specifies coverage criteria for four conditions: chronic lymphocytic leukemia/small lymphocytic lymphoma, Waldenstrom's macroglobulinemia, marginal zone lymphoma, and chronic graft versus host disease, with specific exclusions for patients who have experienced disease progression while on this medication.
Action Required
Before January 1, 2026: Medical billing team must update prior authorization procedures for Imbruvica (ibrutinib) prescriptions for Medicare Advantage patients. Review patient diagnoses against the four covered conditions (CLL/SLL, Waldenstrom's macroglobulinemia, marginal zone lymphoma, and chronic GVHD) and ensure all criteria are met before submitting PA requests. Document that patients have not experienced disease progression while on prior Imbruvica therapy, as this is an exclusion criterion for all indications.