Medicare AdvantagePrior AuthMedium impact
Spevigo® (spesolimab-sbzo) intravenous solution (Revised)
Humana·Dermatology, Rheumatology·Medicare Advantage
Effective date
Feb 25, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Spevigo® (spesolimab-sbzo) for treating Generalized Pustular Psoriasis flares, effective February 25, 2026. The policy requires prior authorization and mandates specific clinical criteria including specialist oversight (dermatology/rheumatology), documented GPP flare severity scores, and prior treatment failure or contraindication to oral systemic therapies. Billing teams must ensure all Spevigo requests meet these three criteria before claims processing.
Action Required
By February 25, 2026: Billing and clinical teams must implement prior authorization requirements for all Spevigo (spesolimab-sbzo) IV solution requests. (1) Update billing system to flag all Spevigo claims requiring prior authorization review before submission. (2) Providers and clinical staff must verify prescribing provider is a dermatologist or rheumatologist, document Generalized Pustular Psoriasis Global Assessment score of 3+, body surface area involvement ≥5% with erythema and pustules, and confirm prior treatment failure/intolerance to oral systemic agents (acitretin, methotrexate) or documented contraindication. (3) Front desk/authorization staff must obtain complete clinical documentation before submitting prior auth requests to Humana. (4) Update encounter templates and prior auth forms to include required severity assessment criteria. Claims submitted without documented prior authorization or missing required clinical criteria will be denied. Reference source: https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a4cad9d