Medicare AdvantagePrior AuthMedium impact
Besponsa™ (inotuzumab ozogamicin) (Revised)
Humana·FL, KY · Oncology, Hematology·Medicaid
Effective date
Nov 26, 2025
We identified it
Jun 25, 2026
Summary
Humana updated its Besponsa (inotuzumab ozogamicin) pharmacy coverage policy, effective November 26, 2025. This is a revision to an existing prior authorization policy for relapsed/refractory B-cell precursor acute lymphoblastic leukemia (ALL) treatment. The policy requires prior authorization for all Besponsa use and mandates strict clinical criteria including CD22 blast confirmation and monotherapy use. Claims submitted without meeting all four approval criteria or containing the disease progression exclusion will be denied.
Action Required
By November 26, 2025: Billing team must ensure Besponsa (inotuzumab ozogamicin) claims are submitted with prior authorization. Verify FOUR required criteria before claim submission: (1) member diagnosis of B-cell precursor ALL, (2) relapsed or refractory disease documented, (3) CD22 blasts confirmed in bone marrow or peripheral blood, and (4) Besponsa prescribed as monotherapy only. Do NOT bill if member has experienced disease progression on or after Besponsa treatment. Update billing system rules to flag Besponsa claims for manual review if any criteria are missing. Communicate to oncology providers that prior authorization approvals are valid for initial 6 months (maximum 6 cycles) and renewals require reapproval. Failure to obtain prior authorization or submit claims meeting all criteria will result in claim denials for Medicare, Florida Medicaid, and Kentucky Medicaid members.