Medicare AdvantagePrior AuthMedium impact
Tremfya (guselkumab) (Revised)
Humana·Dermatology, Rheumatology, Gastroenterology·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised their prior authorization policy for Tremfya (guselkumab), expanding coverage to include new indications for Ulcerative Colitis and Crohn's Disease alongside existing Plaque Psoriasis and Psoriatic Arthritis coverage. The policy now covers both IV and subcutaneous formulations with specific age and weight requirements varying by indication.
Action Required
By January 1, 2025: Billing team must update prior authorization procedures for Tremfya (guselkumab) to include new indications for Ulcerative Colitis and Crohn's Disease for patients 18+ years old. Update authorization request forms to capture specific age and weight requirements: 6+ years and 40kg minimum for Plaque Psoriasis/Psoriatic Arthritis, 18+ years for UC/Crohn's Disease. Ensure providers document prior therapy requirements for psoriasis patients.