Medicare AdvantagePrior AuthMedium impact
Xatmep™ (methotrexate) oral solution (Revised)
Humana·Oncology, Pediatrics, Rheumatology +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has updated its prior authorization policy for Xatmep™ (methotrexate) oral solution, effective January 1, 2025, with a revision dated October 22, 2025. The policy covers two pediatric indications: acute lymphoblastic leukemia (ALL) in patients under 18 as part of combination chemotherapy maintenance, and polyarticular juvenile idiopathic arthritis (pJIA) in patients under 18 with prior treatment failure or intolerance to generic methotrexate. Prior authorization is required for all Xatmep claims under this Medicare Advantage plan.
Action Required
By January 1, 2025: Billing team must implement prior authorization requirement for all Xatmep (methotrexate) oral solution claims submitted to Humana Medicare Advantage. Update billing system to flag Xatmep claims as requiring prior auth before submission. Providers must document: (1) diagnosis of ALL or pJIA, (2) patient age under 18 years, (3) for ALL—confirmation of multi-phase combination chemotherapy maintenance regimen, (4) prior treatment attempt or documented intolerance to generic methotrexate, and (5) any BvsD (Brand vs Disproportionately Branded Drug) coverage determination if applicable. Before submitting claims, verify member is not experiencing disease progression on Xatmep (for ALL indications only). Contact Humana's PAL (Preauthorization and Notification List) portal at www.humana.com/PAL to obtain specific medical/procedural coding information for authorization requests. Failure to obtain prior authorization will result in claim denials.