MedicaidPrior AuthHigh impact
Rituximab products (Revised)
Humana·LA · Oncology, Hematology, Rheumatology +1 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Louisiana Medicaid updated prior authorization requirements for rituximab products (Rituxan, Ruxience, Riabni, Truxima) across multiple conditions including cancers, autoimmune diseases, and rheumatoid arthritis. The policy establishes specific approval criteria and exclusions for each indication, with preference given to biosimilar products Ruxience and Riabni over brand-name Rituxan and Truxima.
Action Required
By January 1, 2026: Billing team must implement prior authorization workflows for all rituximab products (Rituxan, Ruxience, Riabni, Truxima) for Louisiana Medicaid patients. Update system to require documentation of specific approval criteria based on diagnosis (CLL, NHL, RA, etc.) and prior treatment failures. For brand products Rituxan/Truxima, require documentation of intolerance or contraindication to biosimilars Ruxience/Riabni. Educate providers on maintenance therapy duration limits and exclusions to prevent claim denials.