CommercialPrior AuthMedium impact
Methotrexate Injection (Otrexup®, Rasuvo®) (Revised)
Humana·Rheumatology, Dermatology, Pediatrics·Commercial
Effective date
Jan 24, 2024
We identified it
Jun 25, 2026
Summary
Humana revised its prior authorization policy for Methotrexate Injection (Otrexup and Rasuvo) effective January 24, 2024. The policy maintains three indications (Rheumatoid Arthritis, Polyarticular Juvenile Idiopathic Arthritis, and Psoriasis) with a consistent requirement: members must have previous treatment or documented intolerance with generic methotrexate (oral or injection) AND Reditrex before approval. Initial approvals are granted for plan year durations or as determined through clinical review.
Action Required
By January 24, 2024: Billing and clinical teams must ensure all prior authorization requests for Otrexup and Rasuvo include documented evidence of previous treatment failure or intolerance with BOTH generic methotrexate (oral or injection formulation) AND Reditrex. Update prior authorization submission templates and clinical documentation checklists to capture this dual requirement. Verify member eligibility against the three approved indications (RA, pJIA, or severe psoriasis only). Train front-office staff to flag incomplete requests that lack evidence of the required prior methotrexate/Reditrex treatment history. Claims submitted without documented prior treatment or intolerance evidence will be denied or require resubmission with additional documentation.