Medicare AdvantagePrior AuthMedium impact
Vonjo® (pacritinib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its prior authorization policy for Vonjo® (pacritinib) effective January 1, 2026, with updates through May 27, 2026. The policy requires prior authorization for this JAK inhibitor when used as monotherapy for intermediate or high-risk myelofibrosis patients with platelet counts below 50 × 10⁹/L. Billing teams must verify all four approval criteria are met before claim submission and deny coverage for patients with prior disease progression on the drug.
Action Required
By January 1, 2026 (or immediately if after this date): (1) Billing team must implement prior authorization requirement in billing system for all Vonjo (pacritinib) prescriptions for Medicare Advantage members. (2) Create or update prior auth submission templates to verify: (a) diagnosis of primary or secondary myelofibrosis (post-PV or post-ET), (b) risk stratification category (Intermediate or High per IPSS/DIPSS/DIPSS-PLUS), (c) monotherapy status, and (d) platelet count below 50 × 10⁹/L. (3) Flag for denial any claims where member has documented disease progression while on prior Vonjo therapy. (4) Providers and prior auth staff must reference current prescribing information (revised March 2026) for dosing and monitoring requirements. (5) Update claim denial templates to cite this specific policy. Failure to obtain prior authorization will result in claim denials for Medicare Advantage members.