Medicare AdvantagePrior AuthHigh impact
Asthma Interleukin Inhibitors (Cinqair®, Nucala™, Fasenra®) (Revised)
Humana·Pulmonology, Allergy & Immunology, Pediatrics·Medicare Advantage
We identified it
Jul 21, 2026
Summary
This is a revised Prior Authorization policy for asthma interleukin inhibitors (Cinqair®, Nucala™, Fasenra®) affecting Medicare Advantage members. The policy update was released 1 day ago and supersedes any previous guidance on these biologics. Billing teams must verify current prior authorization requirements before submitting claims for these medications.
Action Required
URGENT - By end of business today: (1) Billing team must access the full policy document at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a58485c to extract specific prior authorization requirements, medical necessity criteria, and any coding guidance. (2) Update prior authorization workflow in billing system to reflect revised requirements for Cinqair®, Nucala™, and Fasenra® claims. (3) Notify providers and clinical staff of the policy revision and confirm new PA submission procedures. (4) Review any pending or recently submitted claims for these biologics to ensure compliance with revised policy. (5) Post updated guidance in provider portal and billing procedures manual. NOTE: This summary contains limited detail - full policy content must be reviewed to implement complete billing changes. Failure to obtain proper prior authorization will result in claim denials.