Medicare AdvantagePrior AuthMedium impact
Darzalex® (daratumumab) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Jan 28, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Darzalex (daratumumab) prior authorization policy effective January 28, 2026, for Medicare and three state Medicaid programs (Florida, Kentucky, South Carolina). The policy clarifies coverage criteria for newly diagnosed and relapsed/progressive multiple myeloma, specifying required combination therapies and prior treatment thresholds. No substantive clinical coverage changes are apparent—this is a policy refinement/republication.
Action Required
By January 28, 2026: Billing team must verify current policy version in billing system for all Darzalex (daratumumab) prior authorization requests. Compare existing approval criteria against this revised policy, particularly for newly diagnosed vs. relapsed/progressive disease scenarios and required combination drug regimens. Update prior auth checklist templates and provider education materials to reflect current criteria. For Humana Medicare Advantage and Medicaid (FL, KY, SC) members: Ensure all new Darzalex requests include documentation of disease stage (newly diagnosed or relapsed/progressive), prior therapies received, and specific combination regimen being used. Denial risk if prior authorization does not align with revised criteria. Confirm policy version at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a515ab5 before submitting any requests.