Medicare AdvantagePrior AuthMedium impact
Rinvoq (upadacitinib) LQ Oral Solution (New)
Humana·Rheumatology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage is implementing new prior authorization requirements for Rinvoq (upadacitinib) LQ Oral Solution effective January 1, 2026. The policy covers two specific conditions: psoriatic arthritis and polyarticular juvenile idiopathic arthritis, both requiring patients to be 2+ years old and have prior TNF blocker therapy failure.
Action Required
Before January 1, 2026: Billing team must update prior authorization protocols for Rinvoq LQ oral solution prescriptions. Ensure documentation includes diagnosis of psoriatic arthritis or polyarticular juvenile idiopathic arthritis, patient age 2+ years, and history of TNF blocker therapy failure/contraindication/intolerance (Humira, adalimumab variants, Enbrel). Providers must submit prior auth requests through Humana's system before prescribing. Claims will be denied without proper prior authorization.