Medicare AdvantagePrior AuthMedium impact
Rinvoq (upadacitinib) Extended Release Tablet (New)
Humana·Rheumatology, Dermatology, Gastroenterology +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Rinvoq (upadacitinib) extended release tablets covering 9 different conditions including rheumatoid arthritis, psoriatic arthritis, and Crohn's disease. All covered indications require prior therapy with TNF blockers except atopic dermatitis (requires one systemic therapy) and giant cell arteritis (no prior therapy requirement).
Action Required
By January 1, 2026: Billing team must update prior authorization systems to require approval for all Rinvoq (upadacitinib) prescriptions for Humana Medicare Advantage patients. Providers must document diagnosis-specific criteria including age requirements, disease severity, and prior TNF blocker therapy history before prescribing. Update encounter forms to include prior authorization reminders for rheumatology, dermatology, and gastroenterology visits where Rinvoq may be prescribed.