Medicare AdvantagePrior AuthMedium impact
Reblozyl® (luspatercept-aamt) (Revised)
Humana·SC, VA · Hematology, Oncology·Medicaid
We identified it
Jul 2, 2026
Summary
This is a revised Prior Authorization policy for Reblozyl® (luspatercept-aamt) affecting Medicare and Medicaid members in South Carolina and Virginia. The billing team must obtain prior authorization before dispensing this medication for eligible members on these plans.
Action Required
Billing and pharmacy teams must: (1) Access the complete policy document at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5c4 to identify specific prior authorization requirements, approval criteria, and any effective dates; (2) Update pharmacy systems and billing software to flag Reblozyl® claims for South Carolina and Virginia Medicaid and Medicare members requiring prior authorization submission; (3) Implement prior authorization submission workflows before dispensing; (4) Train pharmacy and billing staff on the revised criteria; (5) Communicate with prescribers in SC and VA about prior authorization requirements. Claims submitted without required prior authorization will be denied.