Medicare AdvantagePrior AuthLow impact
Hypomethylating agents (azacitidine, decitabine) (Revised)
Humana·Hematology, Oncology·Medicare Advantage
Effective date
Jan 1, 2023
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for hypomethylating agents (azacitidine and decitabine) effective January 1, 2023, with the most recent revision dated June 24, 2026. The policy requires prior authorization for these drugs when used to treat myelodysplastic syndrome (MDS), acute myelogenous leukemia (AML), or myeloproliferative neoplasms, with approval granted for the initial plan year or as determined through clinical review. This is a routine policy reaffirmation with no apparent changes to coverage criteria since the original effective date.
Action Required
No immediate action required. This is a routine policy revision with no substantive changes to prior authorization requirements. Billing and clinical staff should verify this is the current policy version on Humana's website before processing claims for azacitidine or decitabine. Continue existing prior authorization workflows for these agents when treating MDS, AML, or myeloproliferative neoplasms in Medicare Advantage members. No updates to billing software, encounter forms, or processes are necessary unless your practice was not previously following this policy.