Medicare AdvantagePrior AuthHigh impact
Non-preferred adalimumab products
Humana·Rheumatology, Gastroenterology, Dermatology +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
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.
Action Required
Before January 1, 2026: Update prior authorization workflows to require approval for all non-preferred adalimumab biosimilars listed in the policy. Ensure providers document failure of at least two preferred treatments (Humira, Enbrel, or condition-specific alternatives) before prescribing non-preferred products. Update EMR templates and prior auth checklists to include required documentation for the 10 covered conditions. Claims for non-preferred adalimumab products will be denied without proper prior authorization.