Medicare AdvantagePrior AuthMedium impact
Tysabri® (natalizumab) and biosimilar (Revised)
Humana·Neurology, Gastroenterology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization requirements for Tysabri (natalizumab) and its biosimilar Tyruko for Medicare Advantage plans, effective January 1, 2026. The policy establishes specific step therapy requirements for multiple sclerosis and Crohn's disease patients, with different criteria for Part B versus Part D coverage.
Action Required
By January 1, 2026: Update prior authorization protocols for Tysabri and Tyruko infusions. Billing team must verify step therapy requirements are met before treatment - for MS patients, ensure trial of at least two specified oral therapies for Part D requests, or trial of Tyruko/Ocrevus for Part B Tysabri requests. For Crohn's disease, verify prior therapy with infliximab products and ustekinumab/Tremfya. Document continuation of therapy within past 365 days to bypass step therapy for Part B requests. Claims without proper prior authorization will be denied.