Medicare AdvantagePrior AuthMedium impact
Nemluvio® (nemolizumab-ilto)
Humana·Dermatology, Allergy & Immunology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage plans now require prior authorization for Nemluvio (nemolizumab-ilto), a new subcutaneous injection for prurigo nodularis and atopic dermatitis, effective January 1, 2026. All patients must have tried or been contraindicated for Dupixent before approval.
Action Required
Before January 1, 2026: Billing team must implement prior authorization requirements for Nemluvio (nemolizumab-ilto) subcutaneous injections for Humana Medicare Advantage patients. Providers must document patient age requirements (18+ for prurigo nodularis, 12+ for atopic dermatitis), specialist consultation (dermatologist, allergist, or immunologist), and previous Dupixent treatment/contraindication. Update encounter forms and EMR templates to capture required criteria. Claims will be denied without prior authorization approval.