MedicaidPrior AuthMedium impact
Rituxan Hycela™ (rituximab/hyaluronidase) (Revised)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Jun 24, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid-Ohio has revised its prior authorization policy for Rituxan Hycela (rituximab/hyaluronidase) effective June 24, 2026. The policy maintains strict criteria requiring prior IV rituximab treatment and specifies approved uses for chronic lymphocytic leukemia, follicular lymphoma, and diffuse large B-cell lymphoma, with maintenance therapy capped at 2 years for CLL and low-grade lymphomas. Non-malignant uses (e.g., rheumatoid arthritis) remain excluded.
Action Required
By June 24, 2026: Billing and prior authorization teams must ensure all Rituxan Hycela requests for Medicaid-Ohio members include verification of: (1) prior IV rituximab treatment; (2) confirmed diagnosis (CLL, follicular lymphoma, or DLBCL with specific treatment regimen); (3) maintenance therapy does not exceed 2 years for CLL and low-grade lymphomas. Reject or request resubmission of any authorization requests missing this documentation. Update PA submission templates and staff training to reflect the 2-year maintenance cap and treatment combination requirements. Verify the request does not involve non-malignant indications before approval. Claims submitted without prior authorization or not meeting these criteria will be denied.