Medicare AdvantagePrior AuthMedium impact
Besremi (ropeginterferon alfa-2b-njft) (Revised)
Humana·Oncology, Hematology, Internal Medicine·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Jun 25, 2026
Summary
Humana updated its Besremi (ropeginterferon alfa-2b-njft) prior authorization policy for Medicare Advantage members with Polycythemia Vera, effective November 26, 2025. The policy requires prior authorization for all Besremi subcutaneous syringes and maintains six specific exclusion criteria (hepatic decompensation, severe psychiatric disorders, immunosuppressed transplant recipients, hypersensitivity, active autoimmune disease, and disease progression on therapy). No changes to billing codes or coverage criteria are noted compared to the original effective date; this is a routine policy revision.
Action Required
By November 26, 2025: Billing team must ensure all Besremi (ropeginterferon alfa-2b-njft) claims for Medicare Advantage members are submitted with prior authorization. Verify member eligibility against the six exclusion criteria (hepatic decompensation Child-Pugh >6, severe psychiatric disorders/suicidal ideation, transplant recipients, interferon hypersensitivity, active autoimmune disease, prior disease progression on Besremi) before claim submission. Update billing system to flag any Besremi requests and route to prior authorization department. Inform oncology and hematology providers that initial and renewal authorizations are approved for the plan year duration or as determined through clinical review. Claims submitted without prior authorization will be denied.