MedicaidPrior AuthHigh impact
Rituximab products (Revised)
Humana·IN · Oncology, Hematology, Rheumatology +1 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Indiana Medicaid has updated their prior authorization policy for rituximab products (Rituxan, Ruxience, Riabni, Truxima), establishing preferential use of biosimilars Ruxience and Riabni, with brand products requiring documentation of intolerance or contraindication to biosimilars. The policy covers multiple oncologic, hematologic, rheumatologic, and autoimmune conditions with specific clinical criteria for each indication.
Action Required
By January 1, 2026: Prior authorization team must implement new rituximab product hierarchy requiring biosimilars (Ruxience or Riabni) as first-line therapy. For Rituxan or Truxima requests, obtain and document patient intolerance or contraindication to biosimilars. Update prior auth workflows to verify specific clinical criteria for each covered indication including CLL, ITP, NHL, Hodgkin's disease, rheumatoid arthritis, Waldenstrom's macroglobulinemia, post-transplant lymphoproliferative disorder, Wegener's granulomatosis, microscopic polyangiitis, and pemphigus vulgaris. Requests without proper documentation will be denied.