Medicare AdvantagePrior AuthMedium impact
Yartemlea (narsoplimab-wuug)
Humana·KY, SC · Oncology, Hematology, Pediatrics·Medicaid
Effective date
Mar 25, 2026
We identified it
Jun 25, 2026
Summary
Humana has established a new prior authorization pharmacy coverage policy for Yartemlea (narsoplimab-wuug), effective March 25, 2026, covering Medicare and Medicaid members in Kentucky and South Carolina. The drug is approved only for adult and pediatric patients (age 2+) with hematopoietic stem cell transplant-associated thrombotic microangiopathy (TA-TMA), with initial and renewal approvals based on plan year duration or clinical review.
Action Required
By March 25, 2026: Billing and prior authorization teams must implement the following: (1) Update billing system and prior authorization workflows to flag Yartemlea (narsoplimab-wuug) claims as requiring prior authorization for Medicare and Medicaid members in Kentucky and South Carolina only; (2) Create or update authorization request templates to verify the single approval criterion—member has confirmed diagnosis of TA-TMA (hematopoietic stem cell transplant-associated thrombotic microangiopathy); (3) Train clinical review staff on approval duration parameters (initial: plan year duration or as determined by clinical review; renewal: plan year duration or as determined by clinical review); (4) Configure system alerts to route Yartemlea requests through clinical review process before claim submission; (5) Update provider communications and billing guidelines to reflect that prior authorization is mandatory for this drug in affected states/plans. Providers submitting claims without prior authorization for affected members will experience claim denials. Reference Humana PAL website (www.humana.com/PAL) for applicable medical and procedural coding information.