Medicare AdvantagePrior AuthMedium impact
Venclexta™ (venetoclax) (Revised)
Humana·Hematology, Oncology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
This is a revised prior authorization policy for Venclexta (venetoclax) tablets for Medicare Advantage plans, covering treatment of chronic lymphocytic leukemia, mantle cell lymphoma, and acute myeloid leukemia. The policy establishes specific criteria for approval based on diagnosis, prior therapy history, and combination treatments.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Venclexta (venetoclax) prescriptions for Medicare Advantage patients. Verify patient meets specific criteria for CLL, MCL, or AML diagnosis and treatment history before submitting prior auth requests. Claims without proper prior authorization will be denied.