Medicare AdvantagePrior AuthMedium impact
Orencia (abatacept) Intravenous (New)
Humana·Rheumatology, Oncology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Orencia (abatacept) IV infusions under Medicare Advantage plans, requiring specific step therapy criteria for rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, and graft vs. host disease prophylaxis. Providers must obtain prior auth before administering this biologic medication starting January 1, 2026.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for Orencia (abatacept) IV infusions for Medicare Advantage patients. Update authorization workflows to verify patient diagnosis, age requirements, and prior therapy history before scheduling infusions. Providers must document step therapy requirements including prior use of Remicade, Inflectra, Infliximab, or Simponi Aria. Claims without proper prior authorization will be denied.