Medicare AdvantagePrior AuthMedium impact
Lunsumio® & Lunsumio Velo™ (mosunetuzumab-axgb) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Feb 25, 2026
We identified it
Jun 25, 2026
Summary
Humana has revised its prior authorization policy for Lunsumio® and Lunsumio Velo™ (mosunetuzumab-axgb) effective February 25, 2026. The policy covers treatment of relapsed or refractory follicular lymphoma in adult patients who have received at least two prior lines of systemic therapy and will use the drug as monotherapy. Prior authorization is required, with initial and renewal approvals valid for 6 months. Claims will be denied if patients experience disease progression while on or after Lunsumio/Lunsumio Velo treatment.
Action Required
By February 25, 2026: Billing team must implement prior authorization requirement in billing system for all Lunsumio and Lunsumio Velo claims submitted for Medicare, Medicaid-Florida, Medicaid-Kentucky, and Medicaid-South Carolina members. Update claim submission workflows to block claims without prior authorization approval. Providers must document: (1) follicular lymphoma diagnosis, (2) relapsed or refractory disease status, (3) minimum two prior lines of systemic therapy completion, and (4) monotherapy use (no combination therapy). Set internal alerts to flag any claims showing disease progression during or after treatment for denial review. Train billing staff that this is a pharmacy prior authorization policy requiring coordination with the member's pharmacy benefit manager. Update provider portals and claim submission instructions to reflect 6-month approval windows for initial and renewal requests. Failure to obtain prior authorization will result in automatic claim denials.