Medicare AdvantagePrior AuthMedium impact
Scemblix® (asciminib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Dec 15, 2021
We identified it
Jun 25, 2026
Summary
Humana updated its Scemblix (asciminib) pharmacy coverage policy for Medicare Advantage members effective December 15, 2021, with the most recent revision on April 22, 2026. The policy maintains prior authorization requirements for this tyrosine kinase inhibitor used to treat Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) in chronic phase, covering newly diagnosed disease, previously treated disease, and disease with T315I mutation. Coverage is denied if the member experiences disease progression while on Scemblix.
Action Required
By April 22, 2026: Billing team must verify this is the current Scemblix policy version by visiting Humana's online policy portal before processing any claims or prior authorization requests. Update internal policy files to reflect the April 22, 2026 revision date. For all Medicare Advantage members requesting Scemblix: (1) Confirm diagnosis of Ph+ CML in chronic phase is documented; (2) Verify member meets ONE of the three criteria (newly diagnosed, previously treated, or T315I mutation); (3) Ensure no prior progression on Scemblix is documented (automatic denial exclusion); (4) Submit prior authorization request with clinical documentation supporting medical necessity; (5) Do not process claims without prior auth approval. Failure to obtain prior authorization will result in claim denials. Reference the full policy on Humana's portal (dctm.humana.com/Mentor/Web) for complete coding and claim submission instructions.