Medicare AdvantagePrior AuthMedium impact
Kineret (anakinra) (New)
Humana·SC · Rheumatology, Allergy & Immunology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana is implementing a new prior authorization policy for Kineret (anakinra) injections effective January 1, 2026, covering three conditions: rheumatoid arthritis, CAPS, and DIRA. This policy requires specific criteria to be met before approval for Medicare and Medicaid patients in South Carolina.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for Kineret (anakinra) subcutaneous injections for Humana Medicare and Medicaid patients in South Carolina. Update billing system to flag these claims for prior auth. Providers must document diagnosis criteria: for RA patients (age 18+, moderate-severe RA, failed 2 preferred treatments), for CAPS patients (NOMID diagnosis), and for DIRA patients (DIRA diagnosis). Visit www.humana.com/PAL for specific medical billing codes. Claims without prior authorization will be denied.