Medicare AdvantagePrior AuthHigh impact
Preferred Adalimumab Products (New)
Humana·Rheumatology, Gastroenterology, Dermatology +1 more·Medicare Advantage
We identified it
Jul 2, 2026
Summary
Humana Medicare Advantage has implemented a new prior authorization policy for preferred adalimumab products. This policy requires pre-approval before dispensing specific adalimumab formulations for Medicare Advantage members, affecting rheumatology and other specialties that prescribe this biologic therapy.
Action Required
Immediately: Billing and clinical teams must obtain prior authorization from Humana before dispensing any adalimumab products to Medicare Advantage members. Update your prior authorization workflow and billing system to flag adalimumab prescriptions for Humana MA plans. Contact the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5f3) or Humana's prior auth line to obtain the complete policy details, preferred product list, and submission requirements. Train providers on the new authorization process. Claims submitted without prior authorization will be denied, resulting in member cost-shift and revenue impact. Failure to implement immediately may delay member access to therapy.