Medicare AdvantagePrior AuthMedium impact
Gazyva® (obinutuzumab) (Revised)
Humana·FL, KY, SC · Oncology, Hematology, Rheumatology·Medicaid
Effective date
Jan 1, 2020
We identified it
Jun 25, 2026
Summary
This is a routine revision of Humana's Gazyva (obinutuzumab) prior authorization policy, effective January 1, 2020, with most recent updates on December 17, 2025. The policy covers three indications: Chronic Lymphocytic Leukemia (CLL), Follicular Lymphoma (FL), and Lupus Nephritis (LN) across Medicare and three state Medicaid programs (Florida, Kentucky, South Carolina). No substantive coverage criteria changes are evident from the revision—the policy maintains existing approval requirements, exclusions, and renewal criteria for all three indications.
Action Required
By January 15, 2026: Billing and prior authorization teams must verify this is the current active policy version in Humana systems for Medicare Advantage, Medicaid-Florida, Medicaid-Kentucky, and Medicaid-South Carolina members. Confirm that all Gazyva requests follow the three indication-specific approval pathways: (1) CLL requires diagnosis + one specified combination therapy or monotherapy; (2) FL requires either first-line therapy approval or rituximab-refractory status + initial combination chemotherapy (max 2-year maintenance); (3) Lupus Nephritis requires age 18+, active diagnosis, and concurrent standard therapy. Educate clinical staff that disease progression on Gazyva is an exclusion for all three indications and will result in denial. Update encounter forms and EMR templates to capture required clinical documentation for prior authorization submission. Note: This policy applies only to Humana plans—verify member's insurance before applying these criteria. Claims submitted without proper prior authorization or not meeting criteria will be denied.