Who is affected by this change?

This affects Humana Hematology, Oncology, Internal Medicine, Pediatrics providers on Medicare Advantage plans.

When does this change take effect?

This change is effective Jan 1, 2026.

Medicare AdvantagePrior AuthMedium impact

Deferasirox Products (Revised)

Q: What do I need to do?

Before January 1, 2026: Billing and clinical teams must implement prior authorization requirements for all deferasirox product claims submitted to Humana Medicare Advantage plans. (1) Update billing system to flag all deferasirox/Jadenu/Exjade claims for prior authorization submission before processing. (2) Create/update PA request templates to capture required documentation: for transfusional iron overload—diagnosis of chronic iron overload secondary to RBC transfusions, ferritin level >1000 mcg/L (initial) or >500 mcg/L (renewal), and platelet count verification; for NTDT—diagnosis, liver iron concentration ≥5 mg/gm (initial) or ≥3 mg/gm (renewal), and serum ferritin >300 mcg/L. (3) Train providers to document contraindications screen: platelet counts, eGFR, hepatic function, and performance status before prescribing. (4) Implement renewal monitoring workflow requiring ferritin checks monthly and liver iron imaging every 6 months. (5) Update claim denial protocols to communicate to members if therapy must be discontinued when ferritin falls below thresholds. Failure to obtain prior authorization will result in claim denials. Submit PA requests to Humana with clinical documentation via www.humana.com/PAL or designated Humana portal.

Humana·Hematology, Oncology, Internal Medicine +1 more·Medicare Advantage

Effective date

Jan 1, 2026

We identified it

Jul 1, 2026

Days to comply

—

Summary

Humana has updated its Deferasirox Products prior authorization policy effective January 1, 2026, with a revision date of June 24, 2026. This policy establishes mandatory prior authorization requirements for all deferasirox products (Jadenu, Exjade, and generic formulations) for Medicare Advantage members with chronic iron overload. The policy defines specific clinical criteria for two indications: transfusional iron overload (ferritin >1000 mcg/L initially, >500 mcg/L for renewal) and non-transfusion dependent thalassemia syndromes (liver iron concentration ≥5 mg/gm initially, ≥3 mg/gm for renewal), with absolute contraindications including platelet counts <50,000/microliter and eGFR <40 mL/min/1.73m².

Action Required

Action needed

Before January 1, 2026: Billing and clinical teams must implement prior authorization requirements for all deferasirox product claims submitted to Humana Medicare Advantage plans. (1) Update billing system to flag all deferasirox/Jadenu/Exjade claims for prior authorization submission before processing. (2) Create/update PA request templates to capture required documentation: for transfusional iron overload—diagnosis of chronic iron overload secondary to RBC transfusions, ferritin level >1000 mcg/L (initial) or >500 mcg/L (renewal), and platelet count verification; for NTDT—diagnosis, liver iron concentration ≥5 mg/gm (initial) or ≥3 mg/gm (renewal), and serum ferritin >300 mcg/L. (3) Train providers to document contraindications screen: platelet counts, eGFR, hepatic function, and performance status before prescribing. (4) Implement renewal monitoring workflow requiring ferritin checks monthly and liver iron imaging every 6 months. (5) Update claim denial protocols to communicate to members if therapy must be discontinued when ferritin falls below thresholds. Failure to obtain prior authorization will result in claim denials. Submit PA requests to Humana with clinical documentation via www.humana.com/PAL or designated Humana portal.

Related policy hubs

Humana policies Hematology Oncology Internal Medicine Pediatrics