Medicare AdvantagePrior AuthMedium impact
Reblozyl® (luspatercept-aamt) (Revised)
Humana·VA · Hematology, Oncology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization criteria for Reblozyl (luspatercept-aamt) for Medicare and Virginia Medicaid patients with beta-thalassemia and myelodysplastic syndromes. The policy now requires specific diagnostic criteria, ring sideroblast testing, and documentation of ESA treatment failure or intolerance for MDS patients.
Action Required
By January 1, 2025: Billing team must update prior authorization workflows for Reblozyl (luspatercept-aamt) requests. Providers must document specific criteria including beta-thalassemia diagnosis (excluding S/B+ or Alpha thalassemia), IPSS-R risk scores for MDS patients, ring sideroblast percentages, serum EPO levels ≤500 mU/mL, and ESA treatment history. Update encounter forms to capture required diagnostic elements. Failure to provide complete documentation will result in prior authorization denials.