Medicare AdvantagePrior AuthMedium impact
Blincyto® (blinatumomab) (Revised)
Humana·KY, SC · Hematology, Oncology, Pediatrics·Medicaid
Effective date
Jan 1, 2020
We identified it
Jun 25, 2026
Summary
This is a revised Blincyto (blinatumomab) prior authorization policy effective January 1, 2020, with updates as of August 27, 2025. The policy covers four treatment indications for B-cell acute lymphoblastic leukemia across Medicare and Medicaid (Kentucky and South Carolina). All Blincyto claims require prior authorization with approval valid for the plan year or as determined through clinical review.
Action Required
By September 27, 2025 (30 days from revision): Billing and clinical teams must ensure all Blincyto (blinatumomab) claims for Medicare and Medicaid members in Kentucky and South Carolina include prior authorization. Verify member meets one of four coverage criteria: (1) relapsed/refractory B-cell ALL (Philadelphia chromosome-negative or positive), (2) B-cell precursor ALL with MRD in first/second complete remission, (3) B-cell precursor ALL in consolidation phase, or (4) other specified indications. Update billing system to flag all Blincyto IV kit and IV solution claims for mandatory prior auth review. Train providers to document diagnosis, remission status (if applicable), and treatment phase/therapy type (monotherapy vs. combination with tyrosine kinase inhibitor) on all Blincyto requests. Add clinical alert in EMR for neurological toxicity and cytokine release syndrome BLACK BOX WARNINGS—providers must acknowledge awareness before prescribing. Failure to obtain prior authorization will result in claim denial. This policy applies only to Kentucky and South Carolina Medicaid and Medicare beneficiaries receiving Blincyto.