Medicare AdvantagePrior AuthMedium impact
Joenja® (leniolisib) (Revised)
Humana·Allergy & Immunology, Hematology, Oncology +2 more·Medicare Advantage
Effective date
Sep 27, 2023
We identified it
Jun 25, 2026
Summary
Humana has updated its prior authorization policy for Joenja® (leniolisib) for Medicare Advantage members with activated phosphoinositide 3-kinase delta syndrome (APDS). The policy requires confirmed genetic mutation documentation (PIK3CD or PIK3R1) and prescriber specialty verification before approval. Initial authorization is valid for 6 months, with renewal based on documented clinical benefit.
Action Required
Before September 27, 2023 (if not already implemented): Billing and prior authorization teams must update their systems to require Joenja prior authorization requests to include: (1) confirmation of documented PI3Kδ mutation in either PIK3CD or PIK3R1 gene, (2) prescriber specialty verification (immunologist, hematologist/oncologist, pulmonologist, allergist, or gastroenterologist). Set initial approval duration to 6 months. For renewal requests, verify clinical benefit documentation (e.g., infection frequency reduction, lymphoproliferation decrease, improved organ function). Update prior authorization templates and clinical review criteria in your authorization system. Communicate requirements to relevant providers. Claims for Joenja without proper prior authorization will be denied.