Medicare AdvantagePrior AuthMedium impact
Rasuvo® (methotrexate injection) (Revised)
Humana·Rheumatology, Dermatology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2023
We identified it
Jun 25, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for Rasuvo® (methotrexate injection) effective January 1, 2023, with the most recent revision dated April 22, 2026. The policy maintains prior authorization requirements for three indications: rheumatoid arthritis (requires severe active disease and prior generic methotrexate trial/intolerance), polyarticular juvenile idiopathic arthritis (requires active disease and prior generic methotrexate trial/intolerance), and psoriasis (requires severe, recalcitrant, disabling disease and prior generic methotrexate trial/intolerance). Approval duration is granted in plan year intervals or as determined through clinical review.
Action Required
By April 22, 2026 (revision date): Billing team must verify this is the current Rasuvo prior authorization policy in your system by checking www.humana.com/PAL for the applicable Preauthorization and Notification List. Update all prior authorization workflows and clinical decision support tools to reflect the three covered indications and their specific criteria. Ensure prior authorization requests include documentation of: (1) confirmed diagnosis (severe active RA, active pJIA, or severe recalcitrant disabling psoriasis), and (2) evidence of prior treatment with or documented intolerance to generic methotrexate. Do NOT process Rasuvo claims without prior authorization approval. Train billing and clinical staff that this policy requires demonstration of generic methotrexate failure/intolerance for all three indications. Claims submitted without meeting these criteria will be denied. Reference the full policy at the Humana URL provided before submitting any Rasuvo authorization requests.