Medicare AdvantagePrior AuthMedium impact
Blenrep (belantamab mafodotin-blmf) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has updated its Blenrep (belantamab mafodotin-blmf) prior authorization policy effective December 17, 2025. The policy requires prior authorization for this anti-BCMA antibody drug conjugate used to treat relapsed/refractory multiple myeloma. Key requirements include confirmation of at least 2 prior therapies (proteasome inhibitor + immunomodulatory agent), use in combination with bortezomib and dexamethasone, and monitoring for disease progression and ocular toxicity. Claims will be denied without proper prior authorization.
Action Required
By December 17, 2025: Billing and clinical teams must implement prior authorization requirements for Blenrep in the billing system and provider workflows. (1) Billing team: Configure system to flag all Blenrep claims as requiring prior authorization before submission. (2) Prior authorization staff: Verify all five approval criteria are met: (a) multiple myeloma diagnosis, (b) relapsed/refractory disease, (c) ≥2 prior therapies including proteasome inhibitor and immunomodulatory agent, (d) combination use with bortezomib and dexamethasone (note: corticosteroid can be omitted if intolerance/contraindication documented), and (e) no prior disease progression on Blenrep. (3) Providers: Submit prior authorization requests with clinical documentation supporting eligibility before prescribing or administering Blenrep. (4) Infusion centers/pharmacy: Do not dispense or administer Blenrep without documented prior authorization approval from Humana. (5) Clinical staff: Ensure baseline and pre-dose ophthalmic exams are documented per REMS requirements and included in authorization requests. Failure to obtain prior authorization will result in claim denials. Monitor Humana's PAL (Preauthorization and Notification List) at www.humana.com/PAL for specific medical/procedural coding.