Medicare AdvantagePrior AuthHigh impact
Iclusig® (ponatinib) (Revised)
Humana·Oncology, Hematology, Pharmacy·Medicare Advantage
Effective date
Apr 22, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Iclusig® (ponatinib) prior authorization policy effective April 22, 2026. The policy maintains strict prior authorization requirements for three indications: chronic phase CML (requires failure on 2+ TKIs or T315I mutation), accelerated/blast phase CML (requires no other kinase inhibitors available or T315I mutation), and Ph+ ALL (requires no other kinase inhibitors, T315I mutation, or use with chemotherapy). All approvals exclude members with disease progression on Iclusig. Billing teams must ensure prior authorization is obtained before dispensing for any of these indications.
Action Required
By April 22, 2026: Billing and pharmacy teams must update prior authorization requirements in pharmacy management systems and billing software to enforce Humana's Iclusig (ponatinib) policy. REQUIREMENTS: (1) Configure system to require prior authorization for HCPCS code J8560 (Iclusig ponatinib tablet) for all Humana Medicare Advantage members before claim submission; (2) Providers and pharmacists must document one of the following before PA request: for chronic phase CML—documented resistance/intolerance/contraindication to 2+ TKIs OR T315I mutation; for accelerated/blast phase CML—no other kinase inhibitors indicated OR T315I mutation; for Ph+ ALL—no other kinase inhibitors indicated OR T315I mutation OR combination with chemotherapy; (3) Exclude members with prior disease progression on Iclusig from coverage consideration; (4) Update pharmacy dispatch and billing team workflows to verify PA approval before dispensing; (5) Train pharmacy staff and billing personnel on the three distinct indications and their specific criteria. Failure to obtain prior authorization will result in claim denials and potential member out-of-pocket costs.