Medicare AdvantagePrior AuthMedium impact
Simponi (golimumab) (New)
Humana·Rheumatology, Gastroenterology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana is implementing a new prior authorization policy for Simponi (golimumab) for Medicare Advantage plans effective January 1, 2026. The policy requires members to have tried and failed at least two other medications before Simponi can be approved for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, or ulcerative colitis.
Action Required
Before January 1, 2026: Billing team must update prior authorization procedures for Simponi (golimumab) prescriptions for Medicare Advantage patients. Ensure providers document diagnosis severity, patient age requirements, and prior therapy failures with at least two specified medications before submitting prior auth requests. For rheumatoid arthritis patients, also verify concomitant methotrexate therapy documentation unless contraindicated.