Summary
Humana Medicare Advantage now requires prior authorization for all non-preferred adalimumab biosimilar products (like Hadlima, Cyltezo, Hyrimoz, etc.) effective January 1, 2026. Patients must first fail treatment with two preferred options including Humira, Enbrel, or other condition-specific alternatives before non-preferred biosimilars will be covered.
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What to do
Action · 4 steps
01Before January 1, 2026: Update prior authorization workflows to require approval for all non-preferred adalimumab biosimilars listed in the policy.
02Ensure providers document failure of at least two preferred treatments (Humira, Enbrel, or condition-specific alternatives) before prescribing non-preferred products.
03Update EMR templates and prior auth checklists to include required documentation for the 10 covered conditions.
04Claims for non-preferred adalimumab products will be denied without proper prior authorization.
Original notice
Non-preferred adalimumab products
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Preferred Adalimumab Products (Revised)HighEffective Jan 1, 2026 · Medicare AdvantagePreferred Adalimumab Products (New)HighEffective Jan 1, 2026 · Medicare AdvantageNon-preferred adalimumab products (Revised)HighEffective Jan 1, 2026 · Medicare AdvantagePreferred Adalimumab Products (New)HighEffective Jan 1, 2026 · Medicare AdvantageBrowse every Humana change in the policy list