Medicare AdvantagePrior AuthMedium impact
Wayrilz™ (rilzabrutinib) tablet (Revised)
Humana·Hematology, Internal Medicine·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has issued a revised prior authorization policy for Wayrilz™ (rilzabrutinib) tablet for persistent or chronic immune thrombocytopenia (ITP). The policy requires prior authorization and mandates that patients must have disease duration ≥3 months, be treated by a hematologist/specialist, not be using Wayrilz as first-line therapy, and have failed or be contraindicated to eltrombopag (preferred agent) before approval. This is a 1-day-old policy effective November 26, 2025, with a recent revision date of April 22, 2026.
Action Required
By April 22, 2026 (revision date): Billing and clinical teams must implement prior authorization requirements for all Wayrilz™ (rilzabrutinib) tablet prescriptions for Medicare Advantage members. Before submitting any Wayrilz claims, verify that: (1) member has persistent or chronic ITP with ≥3 months disease duration; (2) prescriber is a hematologist or appropriate specialist; (3) Wayrilz is NOT first-line therapy; and (4) member has documented prior trial, failure, or contraindication to eltrombopag. Update billing system to flag Wayrilz claims for mandatory prior authorization review. Notify all hematology and internal medicine providers that Wayrilz requires prior auth and cannot be billed as first-line ITP treatment. Submit prior authorization requests via www.humana.com/PAL using applicable preauthorization and notification lists. Claims submitted without prior authorization approval will be denied. Ensure EMR templates and billing encounter forms include checkboxes to confirm all four approval criteria are met before claim submission.