Medicare AdvantagePrior AuthMedium impact
Kineret (anakinra) (Revised)
Humana·SC · Rheumatology, Allergy & Immunology, Internal Medicine·Medicaid
We identified it
Jul 1, 2026
Summary
Humana has revised its Prior Authorization policy for Kineret (anakinra) affecting Medicare and Medicaid members in South Carolina. This is a summary-only policy update that requires immediate review to determine specific authorization requirements and billing workflow changes for rheumatology and immunology practices.
Action Required
Immediately: Obtain and review the complete Kineret (anakinra) policy document from Humana at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a602. Billing team and clinical staff must: (1) Identify the HCPCS code for anakinra injection and any quantity/dosage restrictions; (2) Determine whether prior authorization is required for all members or specific diagnoses; (3) Identify required clinical documentation and medical necessity criteria; (4) Update billing system rules and prior auth request templates; (5) Notify providers in South Carolina to submit prior auth requests before dispensing. Document the effective date and all requirements in practice protocols. Failure to obtain prior authorization may result in claim denials for South Carolina Medicaid and Medicare members.