Medicare AdvantagePrior AuthLow impact
Mavenclad® (cladribine) (Revised)
Humana·Neurology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Mavenclad (cladribine) used to treat relapsing forms of multiple sclerosis. The policy requires members to have tried at least two other MS therapies first and excludes patients with current malignancy, HIV, or active infections.
Action Required
By January 1, 2026: Providers prescribing Mavenclad (cladribine) for Medicare Advantage patients must obtain prior authorization through Humana. Document that patient has relapsing MS, has tried at least two other MS therapies (dimethyl fumarate, fingolimod, glatiramer, Kesimpta, or teriflunomide), and has ruled out malignancy, HIV, hepatitis, and tuberculosis. Note that approval is limited to no more than 2 treatment courses within a 2-year period.