Medicare AdvantagePrior AuthHigh impact
Revlimid (lenalidomide) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised their prior authorization policy for Revlimid (lenalidomide) and generic lenalidomide, establishing specific clinical criteria for various cancer conditions including multiple myeloma, myelodysplastic syndromes, and lymphomas. The policy requires brand Revlimid requests to demonstrate intolerance or contraindication to generic lenalidomide, with detailed approval criteria for each indication.
Action Required
By January 1, 2026: Clinical and billing teams must implement prior authorization requirements for all Revlimid and lenalidomide requests for Medicare Advantage patients. Providers must document specific clinical criteria including diagnosis confirmation, treatment line, and for brand Revlimid requests, evidence of generic intolerance/contraindication. Update EMR templates to capture required clinical elements and train staff on the restricted REMS distribution program requirements. Claims without proper prior authorization will be denied.