Medicare AdvantagePrior AuthMedium impact
Tyenne (tocilizumab) subcutaneous
Humana·Rheumatology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage plans now require prior authorization for Tyenne (tocilizumab) subcutaneous injections for rheumatoid arthritis, juvenile idiopathic arthritis, and giant cell arteritis. Specific criteria must be met including age requirements and prior therapy with preferred medications like Humira, Enbrel, or Rinvoq.
Action Required
Before January 1, 2026: Billing team must update prior authorization requirements for Tyenne (tocilizumab) subcutaneous in billing system. Providers treating rheumatoid arthritis, giant cell arteritis, or juvenile idiopathic arthritis must obtain prior auth by documenting diagnosis, age criteria, and prior therapy with Humira, Enbrel, or Rinvoq before prescribing. Update encounter forms and EMR templates to include these requirements. Claims will be denied without proper prior authorization.