Medicare AdvantagePrior AuthLow impact
Enjaymo™ sutimlimab-jome
Humana·KY · Hematology, Internal Medicine·Medicaid
Effective date
Jul 23, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Enjaymo (sutimlimab-jome), a specialty drug for treating cold agglutinin disease in adults. The policy requires meeting 6 specific clinical criteria including diagnosis confirmation, hemoglobin levels, vaccination requirements, and drug interaction restrictions before approval.
Action Required
By July 23, 2025: Billing team must update prior authorization workflows for Enjaymo (sutimlimab-jome) intravenous solution. Ensure providers document all 6 required criteria including cold agglutinin disease diagnosis, hemoglobin ≤10 g/dL, elevated bilirubin, vaccination status, rituximab timing, and absence of lupus. Visit www.humana.com/PAL for specific medical billing codes. Claims will be denied without proper prior authorization for Kentucky Medicaid and Medicare patients.