CommercialPrior AuthMedium impact
Nascobal® (cyanocobalamin) (Revised)
Humana·Hematology, Internal Medicine, Family Medicine +2 more·Commercial
Effective date
May 22, 2024
We identified it
Jun 25, 2026
Summary
Humana updated its Nascobal (cyanocobalamin) nasal spray prior authorization policy on May 22, 2024. The policy establishes clear approval criteria for two distinct indications: (1) pernicious anemia patients in remission from injectable B12 therapy with no nervous system involvement and injectable intolerance, and (2) patients with dietary, drug-induced, or malabsorption-related B12 deficiency who cannot tolerate injectable forms. Prior authorization is required for all Nascobal prescriptions under this commercial policy.
Action Required
By June 21, 2024: Billing team must implement prior authorization requirement for all Nascobal (cyanocobalamin) nasal spray prescriptions. Update billing software and claim submission processes to route Nascobal requests through prior auth workflow before claim submission. Providers must document: (1) for pernicious anemia cases—diagnosis of pernicious anemia, absence of nervous system involvement, prior achievement of healthy B12 levels with injectable cyanocobalamin, and documented intolerance to injectable B12; (2) for B12 deficiency cases—type of deficiency (dietary, drug-induced, or malabsorption-related) and documented intolerance to injectable B12. Add prior auth checklist to EMR templates for hematology/internal medicine providers. Claims submitted without prior authorization will be denied. Front desk staff should flag Nascobal prescriptions during intake for immediate prior auth processing.