Medicare AdvantagePrior AuthMedium impact
Inqovi® (decitabine and cedazuridine) (Revised)
Humana·Hematology, Oncology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization criteria for Inqovi (decitabine and cedazuridine) effective January 1, 2026. The policy establishes specific approval criteria for myelodysplastic syndromes and acute myeloid leukemia, with exclusions for patients who have progressed on hypomethylators.
Action Required
By January 1, 2026: Billing and clinical teams must implement prior authorization requirements for Inqovi prescriptions. Update EMR templates to capture required criteria including MDS/AML diagnosis, age requirements for AML patients (75+ or comorbidities), combination therapy documentation, and exclusion screening for hypomethylator progression. Train staff on new approval criteria to ensure proper documentation before prescription submission.