MedicaidPrior AuthHigh impact
Rituximab products (Revised)
Humana·OH · Oncology, Hematology, Rheumatology +1 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has updated prior authorization requirements for rituximab products (Rituxan, Ruxience, Riabni, Truxima) across multiple conditions including cancers, rheumatoid arthritis, and autoimmune disorders. The policy prioritizes biosimilars Ruxience and Riabni over brand name products, requiring documented intolerance or contraindication for brand name coverage.
Action Required
By January 1, 2026: Billing team must update prior authorization processes for all rituximab products for Humana Medicaid Ohio members. Ensure documentation shows trial or contraindication to Ruxience or Riabni before requesting brand name Rituxan or Truxima. Update provider templates to capture required clinical criteria for each indication including prior treatments, disease severity, and concomitant medications. Claims will be denied without proper prior authorization.