Medicare AdvantagePrior AuthMedium impact
Idhifa® (enasidenib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Jun 25, 2026
Summary
Humana has revised its Idhifa (enasidenib) prior authorization policy effective October 22, 2025. The policy now covers two distinct AML indications: relapsed/refractory AML with IDH2 mutation (as monotherapy or as part of repeating successful induction for late relapse >12 months) and newly diagnosed AML with IDH2 mutation in patients ineligible for intensive induction therapy. Both pathways require prior authorization with 6-month initial and renewal approval periods. Billing teams must implement these specific criteria in their authorization workflows immediately.
Action Required
By October 22, 2025: Billing team and clinical authorization staff must update prior authorization workflows in the system to reflect the two distinct approval pathways for Idhifa. (1) For relapsed/refractory AML: Ensure prior auth requires documentation of AML diagnosis, relapsed/refractory status, IDH2 mutation confirmation, and intended use (monotherapy OR component of repeating initial successful induction for late relapse >12 months). (2) For newly diagnosed AML: Ensure prior auth requires documentation of new AML diagnosis, confirmed ineligibility for intensive induction therapy due to comorbidities, IDH2 mutation confirmation, and monotherapy use. For both pathways, flag any claims where member has experienced disease progression while on or following Idhifa for denial consideration. Set authorization duration to initial 6 months with 6-month renewal cycles. Update encounter templates and prior auth request forms to prompt providers for these specific criteria. Verify clinical staff understand the distinction between the two indications, as claims missing required documentation will be denied. Reference the full 3-page policy document from Humana's website before implementation.