Medicare AdvantagePrior AuthMedium impact
Jylamvo® (methotrexate) oral solution (Revised)
Humana·Oncology, Hematology, Rheumatology +2 more·Medicare Advantage
Effective date
Jun 26, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Jylamvo (methotrexate oral solution) across six conditions including cancer treatments and autoimmune diseases. Coverage requires documented failure, intolerance, or swallowing difficulty with generic methotrexate tablets.
Action Required
Immediately: For Humana Medicare Advantage patients prescribed Jylamvo (methotrexate oral solution), providers must obtain prior authorization by documenting: 1) qualifying diagnosis (ALL, mycosis fungoides, non-Hodgkin lymphoma, rheumatoid arthritis, severe psoriasis, or polyarticular juvenile idiopathic arthritis), 2) previous treatment failure, intolerance, or documented swallowing difficulty with generic methotrexate tablets, and 3) age requirements where specified (>18 years for most conditions). Update EMR templates to include these documentation requirements. Claims will be denied without proper prior authorization.