Medicare AdvantagePrior AuthHigh impact
Preferred Adalimumab Products (New)
Humana·Rheumatology, Gastroenterology, Dermatology +2 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new prior authorization requirements for adalimumab products (Humira and biosimilars) effective January 1, 2026. Each indication has specific age requirements and prior therapy criteria that must be met for approval.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for all adalimumab products (Humira and biosimilars) for Humana Medicare Advantage patients. Update billing system to flag these medications for prior auth. Providers must document age requirements and prior therapy attempts/contraindications based on specific indication before prescribing. Claims will be denied without proper prior authorization approval.