Medicare AdvantagePrior AuthMedium impact
Kevzara (sarilumab) (New)
Humana·Rheumatology, Pediatrics, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage plans now require prior authorization for Kevzara (sarilumab) effective January 1, 2026. This new policy covers three conditions: moderate to severe rheumatoid arthritis, polymyalgia rheumatica, and polyarticular juvenile idiopathic arthritis, each with specific clinical criteria that must be met for approval.
Action Required
By January 1, 2026: Billing team must update prior authorization procedures for Kevzara (sarilumab) prescriptions for Humana Medicare Advantage patients. Providers must document diagnosis-specific criteria including age requirements, prior therapy failures, and contraindications before prescribing. Update EMR templates to include required documentation for rheumatoid arthritis, polymyalgia rheumatica, and juvenile idiopathic arthritis patients. Claims will be denied without proper prior authorization.