Medicare AdvantagePrior AuthMedium impact
Orencia (abatacept) Subcutaneous (New)
Humana·Rheumatology, Dermatology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage plans now require prior authorization for Orencia (abatacept) subcutaneous injections effective January 1, 2026. Patients must meet specific age requirements and have tried/failed at least two other preferred therapies before Orencia will be approved for psoriatic arthritis, rheumatoid arthritis, or juvenile idiopathic arthritis.
Action Required
Before January 1, 2026: Billing and clinical staff must implement prior authorization workflow for all Orencia (abatacept) subcutaneous prescriptions for Humana Medicare Advantage patients. Update EMR templates to document required criteria including diagnosis, age requirements, and prior therapy failures with at least two preferred medications (Humira, Enbrel, Rinvoq, etc.). Train providers on step therapy requirements and contraindication documentation. Claims will be denied without proper prior authorization.