Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
HumanaMedicare Advantage · Prior Auth · Medicaid · FL, KY, SC, VA · Hematology, Oncology, PharmacyHigh impact

Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta) (Revised)

Act
by Mar 15, 2026 (before next plan year renewal)
Effective date
Jan 1, 2023
Identified
Jun 25, 2026

Summary

This revised Humana policy (effective January 1, 2023, revised February 25, 2026) establishes prior authorization requirements for bendamustine products across five covered indications: CLL, Multiple Myeloma, Hodgkin Lymphoma, Non-Hodgkin's Lymphoma, and Waldenström's Macroglobulinemia. The policy specifies strict clinical criteria for each indication and excludes members experiencing disease progression on bendamustine-containing regimens. All bendamustine prescriptions require prior authorization approval for plan year duration.

Get alerts when payers change rules like this one

We check Humana and other payers every day and email you when a change matches your specialty and state.

Get Humana alertsPolicy Monitoring is free. No card required.

What to do

by Mar 15, 2026 (before next plan year renewal) · 5 steps
01Billing team must configure prior authorization requirements in billing software for all bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta) across Humana Medicare Advantage and Medicaid plans in FL, KY, SC, and VA.
02Providers must be educated that ALL bendamustine claims require prior authorization documentation including: specific diagnosis (CLL, MM, HL, NHL subtypes, or Waldenström's), disease status (first-line, relapsed, refractory, or progressive), and confirmation member has not experienced prior disease progression on bendamustine regimens.
03Update encounter forms and EMR templates to include checkboxes for required clinical criteria.
04Front desk staff must flag all bendamustine orders for prior auth submission before dispensing.
05Claims submitted without prior authorization or failing to meet policy criteria will be denied; resubmission with proper authorization required to avoid payment delays.

Codes mentioned

J9033J9034J9035J9036

Original notice

Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta) (Revised)
mcp.humana.com · Always check the source before changing claims.
View original ↗

Related changes

See all Humana changes →
Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta)HighEffective May 1, 2026 · MedicaidBevacizumab products (New)HighEffective Oct 28, 2026 · MedicaidBevacizumab products (New)HighEffective Oct 28, 2026 · MedicaidErbitux (cetuximab) (New)MediumEffective Feb 1, 2026 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesFL policy changesKY policy changesSC policy changesVA policy changesHematologyOncologyPharmacyCode J9033Code J9034Code J9035Code J9036

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account