Medicare AdvantagePrior AuthMedium impact
Bosulif® (bosutinib) (Revised)
Humana·Hematology, Oncology, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Bosulif (bosutinib) prior authorization policy effective January 1, 2022, with the most recent revision on April 22, 2026. This policy requires prior authorization for bosutinib coverage in Medicare Advantage members with Philadelphia chromosome-positive chronic myelogenous leukemia (CML), with specific approval criteria and exclusions based on disease phase, prior treatment, and specific mutations. The billing team must ensure all Bosulif claims include prior authorization documentation and verify member eligibility against the stated clinical criteria before claim submission.
Action Required
By immediate implementation: (1) Billing team must verify all Bosulif (bosutinib) prescriptions for Medicare Advantage members have prior authorization before processing claims. (2) Update billing software to flag all bosutinib tablet and capsule orders for prior auth verification. (3) Verify member meets ALL approval criteria: Philadelphia chromosome-positive CML diagnosis, appropriate disease phase (accelerated/blast phase OR newly-treated chronic phase with intermediate/high-risk score OR low-risk with imatinib contraindication/intolerance OR previously-treated chronic phase), and lacks exclusionary mutations (T315I, V299L, G250E, F317L) or prior disease progression on Bosulif. (4) Providers must document clinical justification for each authorization request. (5) Ensure prior auth is obtained for initial and renewal periods (plan year duration). Claims submitted without documented prior authorization will be denied. Contact Humana at www.humana.com/PAL for specific preauthorization requirements and coding information.