Medicare AdvantagePrior AuthMedium impact
Tyenne (tocilizumab) subcutaneous (New)
Humana·Rheumatology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage is adding a new prior authorization policy for Tyenne (tocilizumab) subcutaneous injections effective January 1, 2026. This requires prior auth for treatment of rheumatoid arthritis, juvenile idiopathic arthritis, and giant cell arteritis with specific step therapy requirements.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflows for Tyenne (tocilizumab) subcutaneous injections. Ensure providers document diagnosis-specific criteria and previous therapy failures with adalimumab, Enbrel, or Rinvoq before prescribing. Update encounter forms to include step therapy documentation requirements for rheumatology patients.