MedicaidPrior AuthHigh impact
Rituximab products (Revised)
Humana·FL, KY, SC · Hematology, Oncology, Rheumatology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana updated prior authorization requirements for rituximab products (Rituxan, Ruxience, Riabni, Truxima) for Medicaid plans in Florida, Kentucky, and South Carolina. The policy requires step therapy with preferred biosimilars (Ruxience or Riabni first) before approving brand name products, except in Florida where this restriction doesn't apply.
Action Required
By January 1, 2026: Billing team must update prior authorization workflows for rituximab products. For Kentucky and South Carolina Medicaid patients, obtain prior auth documenting intolerance or contraindication to Ruxience or Riabni before prescribing Rituxan or Truxima. Update EMR templates to include step therapy documentation requirements. Florida Medicaid patients exempt from step therapy requirement but still need prior auth for all rituximab products.