Medicare AdvantagePrior AuthMedium impact
Pegasys (peginterferon alfa2-a) (Revised)
Humana·Gastroenterology, Infectious Disease, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated its prior authorization policy for Pegasys (peginterferon alfa-2a) injections used to treat chronic hepatitis B and C in both adults and pediatrics. The policy now requires specific criteria to be met including compensated liver disease, combination therapy requirements, and prior treatment failure with first-line medications before approval.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflows for Pegasys injections for Humana Medicare Advantage patients. Providers must document patient meets all specified criteria including diagnosis confirmation, compensated liver disease status, combination therapy plans, and prior treatment failures with Epclusa (hepatitis C) or tenofovir/entecavir (hepatitis B). Update EMR templates to capture required documentation. Claims without proper prior authorization will be denied.