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Non-preferred adalimumab products (Revised)
Act
by Jan 1, 2026 (already effective)
Effective date
Jan 1, 2026
Identified
Jul 2, 2026
Summary
Humana Medicare Advantage is designating multiple adalimumab biosimilar products (Hadlima, Cyltezo, Hyrimoz, Yuflyma, Amjevita, Idacio, Abrilada, Simlandi, and others) as non-preferred, requiring prior authorization for eight indications. Patients must fail two prior treatments with preferred adalimumab products (Humira, adalimumab-adbm, or adalimumab-adaz) or specified alternative biologics before non-preferred products are covered.
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What to do
by Jan 1, 2026 (already effective) · 7 steps
01Billing and clinical teams must implement prior authorization requirements in the billing system for all non-preferred adalimumab products listed in this policy.
02For Medicare Advantage members requesting any of the following products—Hadlima, Cyltezo, Hyrimoz, Yuflyma, Amjevita, Idacio, Abrilada, Simlandi, adalimumab-ryvk, adalimumab-aacf, adalimumab-aaty, adalimumab-fkjp, or adalimumab-bwwd (across all formulations)—staff must verify the member meets ALL criteria for their diagnosis before claim submission.
03Specific requirements vary by indication: (1) Rheumatoid Arthritis, JIA, Plaque Psoriasis, Ankylosing Spondylitis, Psoriatic Arthritis, Crohn's Disease, and Ulcerative Colitis require documented failure of TWO prior treatments from a specified list; (2) Hidradenitis Suppurativa requires failure of preferred adalimumab AND Cosentyx SQ; (3) age restrictions apply per indication (18+, 12+, 6+, or 5+ depending on diagnosis).
04Providers must submit prior authorization requests with clinical documentation demonstrating treatment failure.
05Update encounter forms and EHR templates to include checkboxes for prior treatment history.
06Flag any claims for non-preferred adalimumab products submitted without prior authorization documentation—these will be denied by Humana.
07Revisions effective June 24, 2026 should be reviewed before that date to ensure no additional changes to criteria.
Original notice
Non-preferred adalimumab products (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Preferred Adalimumab Products (Revised)HighEffective Jan 1, 2026 · Medicare AdvantagePreferred Adalimumab Products (New)HighEffective Jan 1, 2026 · Medicare AdvantagePreferred Adalimumab Products (New)HighEffective Jan 1, 2026 · Medicare AdvantageNon-preferred adalimumab productsHighEffective Jan 1, 2026 · Medicare AdvantageBrowse every Humana change in the policy list