Medicare AdvantagePrior AuthMedium impact
Hemady (dexamethasone tablet) (Revised)
Humana·Oncology, Hematology, Pharmacy·Medicare Advantage
Effective date
Mar 25, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Hemady (dexamethasone tablet) prior authorization policy with a revision date of March 25, 2026. The policy requires prior authorization for Hemady when used in combination with other anti-myeloma therapies for multiple myeloma patients who cannot meet treatment goals with generic dexamethasone alternatives. Coverage is approved for plan year durations with potential renewal through clinical review.
Action Required
By March 25, 2026: Billing and clinical teams must implement prior authorization requirement for Hemady (dexamethasone tablet) prescriptions in the practice's billing system and EMR. Update provider order templates to include the three approval criteria: (1) multiple myeloma diagnosis confirmation, (2) concurrent use with other anti-myeloma therapies, and (3) documentation that generic dexamethasone tablets or IV formulations are inadequate. Train billing staff to submit prior authorization requests with medical necessity documentation showing why generic alternatives cannot meet treatment goals. Establish process to request renewal approvals aligned with plan year boundaries or as directed by clinical review. Failure to obtain prior authorization before dispensing will result in claim denials from Humana Medicare Advantage plans.