Medicare AdvantagePrior AuthMedium impact
Xospata® (gilteritinib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Xospata® (gilteritinib) prior authorization policy effective January 1, 2026, with a revision dated May 27, 2026. The policy requires prior authorization for this FLT3 inhibitor and mandates four specific approval criteria: AML diagnosis, relapsed/refractory disease, documented FLT3 mutation positive status, and monotherapy use. Billing teams must ensure all Xospata claims include verification of these criteria before submission to avoid denials.
Action Required
By December 31, 2025: Billing team must implement prior authorization verification process for all Xospata® (gilteritinib) claims submitted to Humana Medicare Advantage plans. Before claim submission, verify and document the following in patient records: (1) confirmed acute myeloid leukemia diagnosis, (2) relapsed or refractory disease status, (3) FLT3 mutation positive test results from FDA-approved test, and (4) confirmation that Xospata will be used as monotherapy (not in combination). Update billing system with prior authorization requirement flag for Xospata. Coordinate with oncology providers to ensure required documentation is attached to authorization requests. Route all Xospata claims through prior authorization workflow before billing. Failure to obtain prior authorization will result in claim denials for Humana Medicare Advantage members.