Medicare AdvantagePrior AuthMedium impact
Rezurock (belumosudil) (Revised)
Humana·Hematology, Oncology, Pharmacy·Medicare Advantage
Effective date
Sep 24, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Rezurock (belumosudil) prior authorization policy effective September 24, 2025. The policy maintains existing coverage criteria for chronic graft-versus-host disease (cGVHD) requiring failure of at least two prior systemic therapies and a medical reason why Jakafi (Ruxolitinib) cannot be used. Key update includes a new exclusion criterion: members experiencing disease progression while on Rezurock are not eligible for continued coverage. Billing teams must implement prior authorization requirements for this pharmacy benefit.
Action Required
By September 24, 2025: Billing and pharmacy teams must implement the updated prior authorization workflow for Rezurock (belumosudil) claims. (1) Update prior authorization system to enforce all three approval criteria: cGVHD diagnosis, failure of at least two prior systemic therapies, and documented medical reason Jakafi cannot be started/continued. (2) Add the new exclusion rule to billing system logic: flag and deny claims for members with documented disease progression while on Rezurock. (3) Brief all clinical reviewers and billing staff on the updated exclusion criterion to prevent inappropriate approvals. (4) Ensure pharmacy benefit managers and prior auth personnel are aware of the Ruxolitinib (Jakafi) alternative requirement before approving Rezurock. Failure to implement the new exclusion criterion may result in claims paid inappropriately for ineligible members and potential overpayment recovery by Humana.